Tandem Autologous-Allogenic HCT Offers Long-Term Remission in Multiple Myeloma

Share this content:
A retrospective follow-up study demonstrates that tandem autologous-allogeneic is safe for standard and high-risk multiple myeloma.
A retrospective follow-up study demonstrates that tandem autologous-allogeneic is safe for standard and high-risk multiple myeloma.

Some patients with multiple myeloma can achieve long-term remission with tandem autologous/allogeneic hematopoietic cell transplantation (HCT), with low acute and long-term toxicities, a study published in Haematology has shown.

In a previous report, researchers at Fred Hutchinson Cancer Research Center presented initial results from 102 patients with MM treated with sequential high-dose melphalan and autologous HCT followed by 200 cGy total body irradiation with or without fludarabine 90 mg/m2 and allogeneic HCT.

This retrospective analysis presents the clinical outcomes of the initial patients plus 142 additional patients, all of whom received both autologous and allogeneic HCT, with a median follow-up of 8.3 years.

Patient characteristics included median age at diagnosis 51 years; 97 (42%) had high-risk cytogenetics; 57 (25%) had high-risk disease according to International Staging System (ISS) stage III and 36 (16%) according to stage R-ISS; 91 (37%) had received more than 1 induction therapy for unresponsive disease.

Donors were 179 human leukocyte antigen (HLA) identical siblings and 65 HLA-matched unrelated donors. A total of 209 patients (86%) received tandem autologous-allogeneic upfront; 35 patients (14%) failed a previous autologous HCT before the planned autologous-allogeneic transplantation.

Primary outcomes were overall survival (OS) and progression-free survival (PFS); secondary end points were cumulative incidences of acute graft-versus-host-disease (GVHD), chronic GVHD, nonrelapse mortality (NRM), disease response, and disease relapse.

Thirty-one patients received maintenance treatment at a median of 86 days after allogeneic transplantation. Five-year rates of OS and PFS were 54% and 31%, respectively; 10-year OS and PFS were 41% and 19%, respectively. Overall NRM at 100 days was 2%; and at 5 years, 14%.

Overall survival and PFS was shorter for patients with induction-refractory disease and those with high-risk biological features. Disease relapse occurred in 152 patients, 117 of whom received salvage treatment. Clinical response was achieved in 83 of the 117 patients with a median duration of survival after relapse of 7.8 years.

In addition, relapse rate was significantly lower in a subset of patients who became negative for minimal residual disease (MRD) by flow cytometry compared with MRD-positive patients.

These results demonstrate that long-term sustained remissions in standard and high-risk MM can be achieved with tandem autologous-allogeneic HCT. However, tandem HCT did not benefit patients with ultra-high-risk disease, and patients who experienced disease progression after autologous HCT failed to response to allogeneic HCT.

Reference

Maffini E, Storer BE, Sandmaier BM, et al. Long term follow-up of tandem autologous-allogeneic hematopoietic cell transplantation for multiple myeloma [published online September 27, 2018]. Haematologica. doi: 10.3324/haematol.2018.200253

You must be a registered member of ONA to post a comment.

Sign Up for Free e-newsletters



Regimen and Drug Listings

GET FULL LISTINGS OF TREATMENT Regimens and Drug INFORMATION

Bone Cancer Regimens Drugs
Brain Cancer Regimens Drugs
Breast Cancer Regimens Drugs
Endocrine Cancer Regimens Drugs
Gastrointestinal Cancer Regimens Drugs
Genitourinary Cancer Regimens Drugs
Gynecologic Cancer Regimens Drugs
Head and Neck Cancer Regimens Drugs
Hematologic Cancer Regimens Drugs
Lung Cancer Regimens Drugs
Other Cancers Regimens
Rare Cancers Regimens
Skin Cancer Regimens Drugs