Clinical Hematology Department
Contributions
Type: Publication Only
Background
Post-induction Autologous Hematopoietic Stem Cell (HSC) Transplantation (aHSCT) remains the standard of care for multiple myeloma pts (MM) who are fit enough to tolerate it. Although treatment guidelines favour transplantation after induction, recent drug developments have lead to prolonged survivals and the ability to salvage patients who were not transplanted at diagnosis, and who now present at aHSCT Centers, referred from hospitals with differing practices regarding the timing for autologous HST and the protocols used.
While it is known that prior treatment can adversely affect the success of HSC collection, consensus is lacking on whether this is only due to the myelotoxicity of the drugs used, or also to the type of regimen chosen.
Aims
We aim to clarify the influence of the type of prior antimyeloma regimens on the success of HSC collection in a real world sample of newly-diagnosed and previously treated patients (pts).
Methods
We analysed 96 MM pts undergoing their first aHCT. HSC collection success was evaluated by the number of peripheral blood autologous CD34+ cells (“PB CD34”), per kilogram, available for infusion at the first transplant (“Number of Cells”).
Results
The median overall survival was 104.5 m after a median follow-up of 59.1 m. Overall, 68.8% of pts underwent their first aHSCT after 1st line therapy, 23.9% after 2nd line and the remaining 7.3% after 3rd line or greater. The mean Number of Cells infused was 3.4±1.9x10^6, 3.3±1.7, and 2.6±0.7, respectively, p=0.05.
The regimens received prior to apheresis ranged from doublets up to seven-drug associations (VBMCP/VBAD), and included alkylator-, bortezomib-, IMID- and anthracycline-based therapies.
Considering pts undergoing aHSCT after 1st line, 40.9% were treated with doublets, 47.0% with triplets and 12.1% with associations of ≥4 antimyeloma agents. Pts receiving doublets were transplanted with a larger number of PB CD34 cells (4.1±2.6 vs 3.0±1.1x10^6, p<0.001), compared to pts receiving ≥3 drug-associations.
Within the same cohort, the 57.6% who were treated with alkylator-based regimens were transplanted with a lower Number of Cells than pts treated with alkylator-free protocols (3.0±1.0 vs 4.1±2.6x10^6, p<0.001). In contrast, neither the presence of anthracyclines nor of bortezomib in the 1st line regimen influenced the success of apheresis; the 21.1% of pts treated with anthracycline-based regimens were infused with 4.1±1.7x10^6 cells vs 3.3±1.9 (p=NS) in pts without anthracyclines; the 74.2% of pts treated with bortezomib-based regimens received 3.4±2.0x10^6 cells vs 3.8±1.7 (p=NS) in pts without bortezomib. Only 7.6% of pts received one of the IMIDs at 1st line in our cohort, limiting our analysis.
We found that 0% of doublet-regimens included alkylators, compared to 96.8% of triplets and 100% of ≥4 drugs (p<0.001). Taking this into account, after multivariate analysis the number of drugs used lost its predictive value, while only the presence of an alkylator maintained its effect over the success of HSC collection.
Summary
We found that the presence of an alkylator in the 1st line regimen negatively impacted HSC collection success, as expected from its myelotoxic effects. Neither the anthracyclines nor proteasome-inhibitors influenced the success of HSC collection.
While there was a significant difference favouring the use of doublets prior to apheresis, this was due to the higher likelihood of the inclusion of an alkylator in higher-number drug-associations.
Our results support the option of saving alkylators for advanced-lines of treatment, in pts who have not yet undergone HSC collection.
Keyword(s): CD34+ cells, Mobilization, Multiple myeloma, Transplant
Session topic: Publication Only
Type: Publication Only
Background
Post-induction Autologous Hematopoietic Stem Cell (HSC) Transplantation (aHSCT) remains the standard of care for multiple myeloma pts (MM) who are fit enough to tolerate it. Although treatment guidelines favour transplantation after induction, recent drug developments have lead to prolonged survivals and the ability to salvage patients who were not transplanted at diagnosis, and who now present at aHSCT Centers, referred from hospitals with differing practices regarding the timing for autologous HST and the protocols used.
While it is known that prior treatment can adversely affect the success of HSC collection, consensus is lacking on whether this is only due to the myelotoxicity of the drugs used, or also to the type of regimen chosen.
Aims
We aim to clarify the influence of the type of prior antimyeloma regimens on the success of HSC collection in a real world sample of newly-diagnosed and previously treated patients (pts).
Methods
We analysed 96 MM pts undergoing their first aHCT. HSC collection success was evaluated by the number of peripheral blood autologous CD34+ cells (“PB CD34”), per kilogram, available for infusion at the first transplant (“Number of Cells”).
Results
The median overall survival was 104.5 m after a median follow-up of 59.1 m. Overall, 68.8% of pts underwent their first aHSCT after 1st line therapy, 23.9% after 2nd line and the remaining 7.3% after 3rd line or greater. The mean Number of Cells infused was 3.4±1.9x10^6, 3.3±1.7, and 2.6±0.7, respectively, p=0.05.
The regimens received prior to apheresis ranged from doublets up to seven-drug associations (VBMCP/VBAD), and included alkylator-, bortezomib-, IMID- and anthracycline-based therapies.
Considering pts undergoing aHSCT after 1st line, 40.9% were treated with doublets, 47.0% with triplets and 12.1% with associations of ≥4 antimyeloma agents. Pts receiving doublets were transplanted with a larger number of PB CD34 cells (4.1±2.6 vs 3.0±1.1x10^6, p<0.001), compared to pts receiving ≥3 drug-associations.
Within the same cohort, the 57.6% who were treated with alkylator-based regimens were transplanted with a lower Number of Cells than pts treated with alkylator-free protocols (3.0±1.0 vs 4.1±2.6x10^6, p<0.001). In contrast, neither the presence of anthracyclines nor of bortezomib in the 1st line regimen influenced the success of apheresis; the 21.1% of pts treated with anthracycline-based regimens were infused with 4.1±1.7x10^6 cells vs 3.3±1.9 (p=NS) in pts without anthracyclines; the 74.2% of pts treated with bortezomib-based regimens received 3.4±2.0x10^6 cells vs 3.8±1.7 (p=NS) in pts without bortezomib. Only 7.6% of pts received one of the IMIDs at 1st line in our cohort, limiting our analysis.
We found that 0% of doublet-regimens included alkylators, compared to 96.8% of triplets and 100% of ≥4 drugs (p<0.001). Taking this into account, after multivariate analysis the number of drugs used lost its predictive value, while only the presence of an alkylator maintained its effect over the success of HSC collection.
Summary
We found that the presence of an alkylator in the 1st line regimen negatively impacted HSC collection success, as expected from its myelotoxic effects. Neither the anthracyclines nor proteasome-inhibitors influenced the success of HSC collection.
While there was a significant difference favouring the use of doublets prior to apheresis, this was due to the higher likelihood of the inclusion of an alkylator in higher-number drug-associations.
Our results support the option of saving alkylators for advanced-lines of treatment, in pts who have not yet undergone HSC collection.
Keyword(s): CD34+ cells, Mobilization, Multiple myeloma, Transplant
Session topic: Publication Only