Contributions
Abstract: PB2482
Type: Publication Only
Background
The role of autologous stem-cell transplantation (ASCT) in relapsed multiple myeloma has not been fully defined and more data are needed.
Aims
To assess the effycacy of second ASCT in patients with relapsed multiple myeloma (MM).
Methods
In this retrospective analysis, we reviewed the charts of the patients who underwent a second ASCT at least 12 months after their first ASCT for relapsed MM at our institution between March 2011 and July 2017. Progression free survival after ASCT, progression free survival after chemotherapy and overall survival were analyzed by the Kaplan-Meier method.
Results
Twenty patients (12 male, 8 female) with a median age of 62 years (48-73) were included. Patients were classified according to the type of myeloma: IgG 8 (40%); IgA 6 (30%); Bence-Jones 5 (25%); IgD 1 (5%). Adverse cytogenetics were present in 10% of the patients, including delp53, t(4; 14) and t(14; 16). HCT-CI was low (<3) in 74% of them: 0 (63%), 1 (11%), 3 (21%), 4 (5%). The median time from the diagnosis of multiple myeloma to the second transplant was 54 months (25-127). The median time from the first transplant to disase was 32.5 months (12-103). The progression-free survival after the first ASCT was <24 months in 30% of patients. PET-CT at the relapse was positive in 14 (71%) patients, and 7 patients (35%) had plasmacytomas. The median number of previous lines of treatment before second ASCT was 2 (2-4). Bortezomib had been administered to 95% of the patients, and immunomodulators to 60%. The last treatment received before the transplant included Lenalidomide in 50% of the cases. The response after salvage therapy prior to transplantation was: stringent complete response 3 (15%); complete response 3 (15%); very good partial response 8 (40%); partial response 6 (30%). Conditioning regimen was Melphalan in 15 patients (75%) and Busulfan-Melfalan in 5 patients (25%). Transplant related mortality was 5%. The second transplantation significantly improved the stringent complete response rate (from 15% to 55%) (p = 0.008). ). With a median follow up of 33,5 months, the median progression free survival after the second ASCT was 30 months, and 37 months after progression. The progression free survival benefit of the second ASCT was confirmed in all risk subgroups: high risk cytogenetic, time from the first ASCT to relapse <24 m, plasmacytoma at relapse, or response after second ASCT.
Conclusion
Our results confirm that second ASCT significantly increases the number of stringent complete responses in multiple myeloma patients relapsed after a first ASCT . Studies with larger sample of patients are needed in the era of the novel drugs.
Session topic: 23. Stem cell transplantation - Clinical
Abstract: PB2482
Type: Publication Only
Background
The role of autologous stem-cell transplantation (ASCT) in relapsed multiple myeloma has not been fully defined and more data are needed.
Aims
To assess the effycacy of second ASCT in patients with relapsed multiple myeloma (MM).
Methods
In this retrospective analysis, we reviewed the charts of the patients who underwent a second ASCT at least 12 months after their first ASCT for relapsed MM at our institution between March 2011 and July 2017. Progression free survival after ASCT, progression free survival after chemotherapy and overall survival were analyzed by the Kaplan-Meier method.
Results
Twenty patients (12 male, 8 female) with a median age of 62 years (48-73) were included. Patients were classified according to the type of myeloma: IgG 8 (40%); IgA 6 (30%); Bence-Jones 5 (25%); IgD 1 (5%). Adverse cytogenetics were present in 10% of the patients, including delp53, t(4; 14) and t(14; 16). HCT-CI was low (<3) in 74% of them: 0 (63%), 1 (11%), 3 (21%), 4 (5%). The median time from the diagnosis of multiple myeloma to the second transplant was 54 months (25-127). The median time from the first transplant to disase was 32.5 months (12-103). The progression-free survival after the first ASCT was <24 months in 30% of patients. PET-CT at the relapse was positive in 14 (71%) patients, and 7 patients (35%) had plasmacytomas. The median number of previous lines of treatment before second ASCT was 2 (2-4). Bortezomib had been administered to 95% of the patients, and immunomodulators to 60%. The last treatment received before the transplant included Lenalidomide in 50% of the cases. The response after salvage therapy prior to transplantation was: stringent complete response 3 (15%); complete response 3 (15%); very good partial response 8 (40%); partial response 6 (30%). Conditioning regimen was Melphalan in 15 patients (75%) and Busulfan-Melfalan in 5 patients (25%). Transplant related mortality was 5%. The second transplantation significantly improved the stringent complete response rate (from 15% to 55%) (p = 0.008). ). With a median follow up of 33,5 months, the median progression free survival after the second ASCT was 30 months, and 37 months after progression. The progression free survival benefit of the second ASCT was confirmed in all risk subgroups: high risk cytogenetic, time from the first ASCT to relapse <24 m, plasmacytoma at relapse, or response after second ASCT.
Conclusion
Our results confirm that second ASCT significantly increases the number of stringent complete responses in multiple myeloma patients relapsed after a first ASCT . Studies with larger sample of patients are needed in the era of the novel drugs.
Session topic: 23. Stem cell transplantation - Clinical