SINGLE CENTRE OUTCOMES OF ALLOGENEIC STEM CELL TRANSPLANTATION FOR MULTIPLE MYELOMA.
(Abstract release date: 05/19/16)
EHA Library. Rider T. 06/09/16; 134854; PB1954
Dr. Tom Rider
Contributions
Contributions
Abstract
Abstract: PB1954
Type: Publication Only
Background
The introduction of novel drugs and autologous stem-cell transplantation (SCT) have improved outcomes in multiple myeloma (MM) but most patients relapse and remain uncured. Allogeneic SCT is a potentially curative therapy but high transplant-related mortality (TRM) limits use of this strategy. Reduced-intensity transplants have reduced TRM but consequently higher relapse rates occur.
Aims
Our primary aim was to evaluate progression free survival (PFS) and overall survival (OS) in patients with MM who underwent allogeneic SCT at our centre. We also examined the effect of several factors on PFS and OS; pre-allogenic SCT disease status, prior autologous SCT and number of lines of treatment, in addition to conditioning regimen, age, and 6 month chimerism levels.
Methods
A retrospective analysis of medical records for all consecutive MM patients that underwent allogeneic transplantation at our centre between May 1999 and December 2015.
Results
29 MM patients underwent allogeneic SCT at a median age of 51 with the median year of transplant being 2005. Prior to allogeneic SCT a median of 3.6 treatment lines (range 2-9) were administered, including an autologous SCT which 79.3% of the cohort received. The subtype of MM was; IgG 48.3%, IgA 20.7%, plasma cell leukaemia 17.2%, kappa light chain myeloma 10.4% and lambda light chain disease 3.4%. Prior to allogeneic SCT 41.2% were in complete remission, 14.8% in very good partial remission (VGPR), 29.2% in partial remission and 14.8% had stable disease.A sibling was the stem cell donor in 57.1% of cases, the remainder had matched unrelated donors. 51.7% of patients received fludarabine, melphalan and alemtuzumab conditioning, 13.8% received fludarabine, busulfan and alemtuzumab, other regimens used included those utilising anti-thymocyte globulin ATG or total body irradiation.PFS and OS were 35 and 56 months respectively. The 10 year PFS was 23% and OS was 49%. 14 deaths occurred during a median follow-up of 58.1 months. Age, pre-allogeneic SCT disease status, 6 month chimerisms and type of conditioning regimen had no significant effect on PFS or OS. Those with fewer than 4 lines of treatment prior to allogeneic SCT had longer OS (P=0.4) and PFS (P=0.015). IMiD therapy was given to 51.7% of patients pre-allogeneic SCT and 27.6% received velcade. Those that received 1 autologous SCT (n=16) had longer OS (P=0.026) compared to those that received 2 (n=7) or no autologous SCT (n=6), but PFS was not affected.Neutrophil engraftment occurred after a median of 13 days. Graft versus host disease in the first 100 days occurred in 4 patients and in 5 patients after 100 days. 4 patients had pre-planned maintenance therapy post allogeneic SCT. Donor lymphocyte infusion was given to 9 patients post allogeneic SCT at a median of 9 months post allogenic SCT, a median of 3 infusions were administered. 2 patients subsequently received an autologous SCT post allogeneic SCT at a median of 36.5 months. A median of 1 line of treatment (range 0-5) were given to the 13 patients who relapsed following allogeneic SCT.
Conclusion
Our data indicates that performing an allogeneic SCT after less than 4 lines of treatment and after 1 autologous SCT yields better outcomes. Low disease burden as demonstrated by achieving at least a VGPR is also optimal, although not significant in our data. The role of immunomodulation including maintenance therapy post allogeneic SCT needs to be fully examined in prospective clinical trials to optimise the chance of allogeneic SCT being curative.
Session topic: E-poster
Keyword(s): Allogeneic bone marrow transplant, Myeloma
Type: Publication Only
Background
The introduction of novel drugs and autologous stem-cell transplantation (SCT) have improved outcomes in multiple myeloma (MM) but most patients relapse and remain uncured. Allogeneic SCT is a potentially curative therapy but high transplant-related mortality (TRM) limits use of this strategy. Reduced-intensity transplants have reduced TRM but consequently higher relapse rates occur.
Aims
Our primary aim was to evaluate progression free survival (PFS) and overall survival (OS) in patients with MM who underwent allogeneic SCT at our centre. We also examined the effect of several factors on PFS and OS; pre-allogenic SCT disease status, prior autologous SCT and number of lines of treatment, in addition to conditioning regimen, age, and 6 month chimerism levels.
Methods
A retrospective analysis of medical records for all consecutive MM patients that underwent allogeneic transplantation at our centre between May 1999 and December 2015.
Results
29 MM patients underwent allogeneic SCT at a median age of 51 with the median year of transplant being 2005. Prior to allogeneic SCT a median of 3.6 treatment lines (range 2-9) were administered, including an autologous SCT which 79.3% of the cohort received. The subtype of MM was; IgG 48.3%, IgA 20.7%, plasma cell leukaemia 17.2%, kappa light chain myeloma 10.4% and lambda light chain disease 3.4%. Prior to allogeneic SCT 41.2% were in complete remission, 14.8% in very good partial remission (VGPR), 29.2% in partial remission and 14.8% had stable disease.A sibling was the stem cell donor in 57.1% of cases, the remainder had matched unrelated donors. 51.7% of patients received fludarabine, melphalan and alemtuzumab conditioning, 13.8% received fludarabine, busulfan and alemtuzumab, other regimens used included those utilising anti-thymocyte globulin ATG or total body irradiation.PFS and OS were 35 and 56 months respectively. The 10 year PFS was 23% and OS was 49%. 14 deaths occurred during a median follow-up of 58.1 months. Age, pre-allogeneic SCT disease status, 6 month chimerisms and type of conditioning regimen had no significant effect on PFS or OS. Those with fewer than 4 lines of treatment prior to allogeneic SCT had longer OS (P=0.4) and PFS (P=0.015). IMiD therapy was given to 51.7% of patients pre-allogeneic SCT and 27.6% received velcade. Those that received 1 autologous SCT (n=16) had longer OS (P=0.026) compared to those that received 2 (n=7) or no autologous SCT (n=6), but PFS was not affected.Neutrophil engraftment occurred after a median of 13 days. Graft versus host disease in the first 100 days occurred in 4 patients and in 5 patients after 100 days. 4 patients had pre-planned maintenance therapy post allogeneic SCT. Donor lymphocyte infusion was given to 9 patients post allogeneic SCT at a median of 9 months post allogenic SCT, a median of 3 infusions were administered. 2 patients subsequently received an autologous SCT post allogeneic SCT at a median of 36.5 months. A median of 1 line of treatment (range 0-5) were given to the 13 patients who relapsed following allogeneic SCT.
Conclusion
Our data indicates that performing an allogeneic SCT after less than 4 lines of treatment and after 1 autologous SCT yields better outcomes. Low disease burden as demonstrated by achieving at least a VGPR is also optimal, although not significant in our data. The role of immunomodulation including maintenance therapy post allogeneic SCT needs to be fully examined in prospective clinical trials to optimise the chance of allogeneic SCT being curative.
Session topic: E-poster
Keyword(s): Allogeneic bone marrow transplant, Myeloma
Abstract: PB1954
Type: Publication Only
Background
The introduction of novel drugs and autologous stem-cell transplantation (SCT) have improved outcomes in multiple myeloma (MM) but most patients relapse and remain uncured. Allogeneic SCT is a potentially curative therapy but high transplant-related mortality (TRM) limits use of this strategy. Reduced-intensity transplants have reduced TRM but consequently higher relapse rates occur.
Aims
Our primary aim was to evaluate progression free survival (PFS) and overall survival (OS) in patients with MM who underwent allogeneic SCT at our centre. We also examined the effect of several factors on PFS and OS; pre-allogenic SCT disease status, prior autologous SCT and number of lines of treatment, in addition to conditioning regimen, age, and 6 month chimerism levels.
Methods
A retrospective analysis of medical records for all consecutive MM patients that underwent allogeneic transplantation at our centre between May 1999 and December 2015.
Results
29 MM patients underwent allogeneic SCT at a median age of 51 with the median year of transplant being 2005. Prior to allogeneic SCT a median of 3.6 treatment lines (range 2-9) were administered, including an autologous SCT which 79.3% of the cohort received. The subtype of MM was; IgG 48.3%, IgA 20.7%, plasma cell leukaemia 17.2%, kappa light chain myeloma 10.4% and lambda light chain disease 3.4%. Prior to allogeneic SCT 41.2% were in complete remission, 14.8% in very good partial remission (VGPR), 29.2% in partial remission and 14.8% had stable disease.A sibling was the stem cell donor in 57.1% of cases, the remainder had matched unrelated donors. 51.7% of patients received fludarabine, melphalan and alemtuzumab conditioning, 13.8% received fludarabine, busulfan and alemtuzumab, other regimens used included those utilising anti-thymocyte globulin ATG or total body irradiation.PFS and OS were 35 and 56 months respectively. The 10 year PFS was 23% and OS was 49%. 14 deaths occurred during a median follow-up of 58.1 months. Age, pre-allogeneic SCT disease status, 6 month chimerisms and type of conditioning regimen had no significant effect on PFS or OS. Those with fewer than 4 lines of treatment prior to allogeneic SCT had longer OS (P=0.4) and PFS (P=0.015). IMiD therapy was given to 51.7% of patients pre-allogeneic SCT and 27.6% received velcade. Those that received 1 autologous SCT (n=16) had longer OS (P=0.026) compared to those that received 2 (n=7) or no autologous SCT (n=6), but PFS was not affected.Neutrophil engraftment occurred after a median of 13 days. Graft versus host disease in the first 100 days occurred in 4 patients and in 5 patients after 100 days. 4 patients had pre-planned maintenance therapy post allogeneic SCT. Donor lymphocyte infusion was given to 9 patients post allogeneic SCT at a median of 9 months post allogenic SCT, a median of 3 infusions were administered. 2 patients subsequently received an autologous SCT post allogeneic SCT at a median of 36.5 months. A median of 1 line of treatment (range 0-5) were given to the 13 patients who relapsed following allogeneic SCT.
Conclusion
Our data indicates that performing an allogeneic SCT after less than 4 lines of treatment and after 1 autologous SCT yields better outcomes. Low disease burden as demonstrated by achieving at least a VGPR is also optimal, although not significant in our data. The role of immunomodulation including maintenance therapy post allogeneic SCT needs to be fully examined in prospective clinical trials to optimise the chance of allogeneic SCT being curative.
Session topic: E-poster
Keyword(s): Allogeneic bone marrow transplant, Myeloma
Type: Publication Only
Background
The introduction of novel drugs and autologous stem-cell transplantation (SCT) have improved outcomes in multiple myeloma (MM) but most patients relapse and remain uncured. Allogeneic SCT is a potentially curative therapy but high transplant-related mortality (TRM) limits use of this strategy. Reduced-intensity transplants have reduced TRM but consequently higher relapse rates occur.
Aims
Our primary aim was to evaluate progression free survival (PFS) and overall survival (OS) in patients with MM who underwent allogeneic SCT at our centre. We also examined the effect of several factors on PFS and OS; pre-allogenic SCT disease status, prior autologous SCT and number of lines of treatment, in addition to conditioning regimen, age, and 6 month chimerism levels.
Methods
A retrospective analysis of medical records for all consecutive MM patients that underwent allogeneic transplantation at our centre between May 1999 and December 2015.
Results
29 MM patients underwent allogeneic SCT at a median age of 51 with the median year of transplant being 2005. Prior to allogeneic SCT a median of 3.6 treatment lines (range 2-9) were administered, including an autologous SCT which 79.3% of the cohort received. The subtype of MM was; IgG 48.3%, IgA 20.7%, plasma cell leukaemia 17.2%, kappa light chain myeloma 10.4% and lambda light chain disease 3.4%. Prior to allogeneic SCT 41.2% were in complete remission, 14.8% in very good partial remission (VGPR), 29.2% in partial remission and 14.8% had stable disease.A sibling was the stem cell donor in 57.1% of cases, the remainder had matched unrelated donors. 51.7% of patients received fludarabine, melphalan and alemtuzumab conditioning, 13.8% received fludarabine, busulfan and alemtuzumab, other regimens used included those utilising anti-thymocyte globulin ATG or total body irradiation.PFS and OS were 35 and 56 months respectively. The 10 year PFS was 23% and OS was 49%. 14 deaths occurred during a median follow-up of 58.1 months. Age, pre-allogeneic SCT disease status, 6 month chimerisms and type of conditioning regimen had no significant effect on PFS or OS. Those with fewer than 4 lines of treatment prior to allogeneic SCT had longer OS (P=0.4) and PFS (P=0.015). IMiD therapy was given to 51.7% of patients pre-allogeneic SCT and 27.6% received velcade. Those that received 1 autologous SCT (n=16) had longer OS (P=0.026) compared to those that received 2 (n=7) or no autologous SCT (n=6), but PFS was not affected.Neutrophil engraftment occurred after a median of 13 days. Graft versus host disease in the first 100 days occurred in 4 patients and in 5 patients after 100 days. 4 patients had pre-planned maintenance therapy post allogeneic SCT. Donor lymphocyte infusion was given to 9 patients post allogeneic SCT at a median of 9 months post allogenic SCT, a median of 3 infusions were administered. 2 patients subsequently received an autologous SCT post allogeneic SCT at a median of 36.5 months. A median of 1 line of treatment (range 0-5) were given to the 13 patients who relapsed following allogeneic SCT.
Conclusion
Our data indicates that performing an allogeneic SCT after less than 4 lines of treatment and after 1 autologous SCT yields better outcomes. Low disease burden as demonstrated by achieving at least a VGPR is also optimal, although not significant in our data. The role of immunomodulation including maintenance therapy post allogeneic SCT needs to be fully examined in prospective clinical trials to optimise the chance of allogeneic SCT being curative.
Session topic: E-poster
Keyword(s): Allogeneic bone marrow transplant, Myeloma
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