Tandem Autologous Stem Cell Transplantation Improves Outcomes in Newly Diagnosed Multiple Myeloma with Extramedullary Disease and High-Risk Cytogenetics: A Study from the Chronic Malignancies Working Party of the European Society for Blood and Marrow Transplantation

Autor: Ibrahim Yakoub-Agha, Xavier Poiré, Marek Trneny, Wilfried Schroyens, Linda Koster, Juan Bargay Lleonart, Denis Caillot, Péter Reményi, Nicolaas Schaap, Loic Fouillard, Anastasia Pouli, Maija Itälä-Remes, Dominique Bron, Nico Gagelmann, Vincenzo Pavone, Didier Blaise, Jean-Yves Cahn, Johan Maertens, Nicolaus Kröger, Rocio Parody Porras, Pietro Pioltelli, Roland Fenk, Jakob Passweg, Diderik Jan Eikema, Maurizio Musso, Stefan Schönland, Laurent Garderet
Přispěvatelé: UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service d'hématologie
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Oncology
Male
Cancer development and immune defence Radboud Institute for Molecular Life Sciences [Radboudumc 2]
humanos
tandem
Myeloma
autologous
estudios de seguimiento
cytogenetics
0302 clinical medicine
Autologous stem-cell transplantation
Risk Factors
extramedullary disease
supervivencia sin enfermedad
Autografts
Multiple myeloma
mediana edad
Societies
Medical
allogeneic
anciano
Marrow transplantation
Hematology
adulto
Middle Aged
Europe
Survival Rate
myeloma
Extramedullary disease
Novel agents
030220 oncology & carcinogenesis
Female
Stem cell
Multiple Myeloma
Autologous
Adult
medicine.medical_specialty
Newly diagnosed
mieloma múltiple
Tandem
Disease-Free Survival
trasplante de células madre
03 medical and health sciences
Cytogenetics
All institutes and research themes of the Radboud University Medical Center
Internal medicine
medicine
factores de riesgo
Humans
aberraciones cromosómicas
tasa de supervivencia
Allogeneic
Aged
Chromosome Aberrations
Transplantation
business.industry
medicine.disease
autoinjertos
Human medicine
business
030215 immunology
Follow-Up Studies
Stem Cell Transplantation
Hématologie
Zdroj: Biology of blood and marrow transplantation
Biology of Blood and Marrow Transplantation, 25, 11, pp. 2134-2142
Biology of Blood and Marrow Transplantation, 25, 2134-2142
Biology of blood and marrow transplantation, Vol. 25, no.11, p. 2134-2142 (2019)
ISSN: 1083-8791
Popis: Although high-dose therapy and autologous stem cell transplant combined with novel agents continues to be the hallmark of first-line treatment in newly diagnosed transplant-eligible multiple myeloma patients, the impact of tandem autologous or autologous/reduced-intensity allogeneic transplant for patients with extramedullary disease (EMD) and high-risk cytogenetics is not yet defined. Here, we analyzed clinical and cytogenetic data from 488 adult myeloma patients with EMD undergoing single autologous (n = 373), tandem autologous (n = 84), or autologous–allogeneic transplant (n = 31) between 2003 and 2015. At least 1 high-risk abnormality was present in 41% (n = 202), with del(17p) (40%) and t(4;14) (45%) the most frequent. More than 1 high-risk abnormality was found in 54%. High-risk cytogenetics showed worse 4-year overall survival (OS) and progression-free survival (PFS) of 54% and 29%, respectively, versus 78% and 49% for standard-risk cytogenetics (P < .001). Co-segregation of high-risk abnormalities did not seem to affect outcome. Regarding transplant regimen, OS and PFS were 70% and 43% for single autologous versus 83% and 52% for tandem autologous and 88% and 58% for autologous–allogeneic (P = .06 and P = .30). In multivariate analysis high-risk cytogenetics were associated with worse survival (hazard ratio [HR], 2.00; P = .003), whereas tandem autologous significantly improved outcome versus single autologous transplant (HRs, 46 and .64; P = .02 and P = .03). Autologous–allogeneic transplant did not significantly differ in outcome but appeared to improve survival, but results were limited because of small population (HR, 31). In conclusion, high-risk cytogenetics is frequently observed in newly diagnosed myeloma with EMD and significantly worsens outcome after single autologous, whereas a tandem autologous transplant strategy may overcome onset poor prognosis.
SCOPUS: ar.j
info:eu-repo/semantics/published
Databáze: OpenAIRE
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