| Autor: |
Lawless S; Belfast City Hospital, Belfast., Iacobelli S; Tor Vergata University, Rome., Knelange NS; EBMT Data Office Leiden, Leiden., Chevallier P; CHU Nantes, Nantes., Blaise D; ICRCM, INSERM, CNRS, AMU and Institut Paoli Calmettes, Marseille., Milpied N; CHU Bordeaux, Pessac., Foà R; Univ.`La Sapienza`, Rome., Cornelissen JJ; Erasmus MC Cancer Institute, Rotterdam., Lioure B; Nouvel Hopital Civil, Strasbourg., Benjamin R; Kings College Hospital, London., Poiré X; Cliniques Universitaires St. Luc, Brussels., Minnema MC; University Medical Center, Utrecht, Utrecht., Collin M; Freeman Hospital, Newcastle., Lenhoff S; Skanes University Hospital, Lund., Snowden JA; Sheffield Teaching Hospitals Foundation Trust, Sheffield., Santarone S; Ospedale Civile, Pescara., Wilson KMO; University Hospital of Wales, Cardiff Wales., Trigo F; Hospital Sao Joao, Porto., Dreger P; University of Heidelberg, Heidelberg., Böhmer LH; Haga Teaching Hospital The Hague., Putter H; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden., Garderet L; Hospital Saint Antoine, Paris., Kröger N; University Hospital Eppendorf, Hamburg., Yaukoub-Agha I; CHU de Lille, Univ Lille, INSERM U1286, Infinite, 59000 Lille, Lille., Schönland S; University of Heidelberg, Heidelberg. Stefan.Schoenland@med.uni-heidelberg.de., Morris C; Queens University of Belfast, Belfast. |
| Abstrakt: |
Primary plasma cell leukemia (pPCL) is a rare and challenging malignancy. There are limited data regarding optimum transplant approaches. We therefore undertook a retrospective analysis from 1998-2014 of 751 patients with pPCL undergoing one of four transplant strategies; single autologous transplant (single auto), single allogeneic transplant (allo-first) or a combined tandem approach with an allogeneic transplant following an autologous transplant (auto-allo) or a tandem autologous transplant (auto-auto). To avoid time bias, multiple analytic approaches were employed including Cox models with time-dependent covariates and dynamic prediction by landmarking. Initial comparisons were made between patients undergoing allo-first (n=70) versus auto-first (n=681), regardless of a subsequent second transplant. The allo-first group had a lower relapse rate (45.9%, 95% confidence interval [95% CI]: 33.2-58.6 vs. 68.4%, 64.4-72.4) but higher non-relapse mortality (27%, 95% CI: 15.9-38.1 vs. 7.3%, 5.2-9.4) at 36 months. Patients who underwent allo-first had a remarkably higher risk in the first 100 days for both overall survival and progression-free survival. Patients undergoing auto-allo (n=122) had no increased risk in the short term and a significant benefit in progression-free survival after 100 days compared to those undergoing single auto (hazard ratio [HR]=0.69, 95% CI: 0.52- 0.92; P=0.012). Auto-auto (n=117) was an effective option for patients achieving complete remission prior to their first transplant, whereas in patients who did not achieve complete remission prior to transplantation our modeling predicted that auto-allo was superior. This is the largest retrospective study reporting on transplantation in pPCL to date. We confirm a significant mortality risk within the first 100 days for allo-first and suggest that tandem transplant strategies are superior. Disease status at time of transplant influences outcome. This knowledge may help to guide clinical decisions on transplant strategy. |
