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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.

  • Gagelmann N University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Eikema DJ EBMT Statistical Unit, Leiden, The Netherlands.
  • Koster L EBMT Data Office, Leiden, The Netherlands.
  • Caillot D Centre Hospitalier Universitaire, Dijon, France.
  • Pioltelli P Ospedale San Gerardo, Monza, Italy.
  • Lleonart JB Hospital son LLatzer, Palma de Mallorca, Spain.
  • Reményi P St. István and St. Laszlo Hospital, Budapest, Hungary.
  • Blaise D Institut Paoli Calmettes, Marseille, France.
  • Schaap N Radboud University Medical Centre, Nijmegen, The Netherlands.
  • Trneny M Charles University Hospital, Prague, Czech Republic.
  • Passweg J University Hospital, Basel, Switzerland.
  • Porras RP ICO-Hospital Duran i Reynals, Barcelona, Spain.
  • Cahn JY Hôpital A. Michallon, Grenoble, France.
  • Musso M Ospedale La Maddalena, Palermo, Italy.
  • Poiré X Cliniques Universitaires St. Luc, Brussels, Belgium.
  • Fenk R Heinrich Heine University, Düsseldorf, Germany.
  • Itälä-Remes M Turku University Hospital, Turku, Finland.
  • Pavone V Hospital C. Panico, Tricase, Italy.
  • Fouillard L Grand Hôpital de l`Est Francilien, Meaux, France.
  • Maertens J University Hospital Gasthuisberg, Leuven, Belgium.
  • Bron D Institut Jules Bordet, Brussels, Belgium.
  • Pouli A St. Savvas Oncology Hospital, Athens, Greece.
  • Schroyens W University Hospital Antwerp, Edegem, Belgium.
  • Schönland S Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Germany.
  • Garderet L Hôpital Saint Antoine, Paris, France.
  • Yakoub-Agha I CHU de Lille, LIRIC, INSEM U995, Université Lille2, Lille, France.
  • Kröger N University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: b.ramme@uke.de.
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  • 2019-07-10
Published in:
  • Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. - 2019
Allogeneic
Autologous
Cytogenetics
Extramedullary disease
Myeloma
Tandem
Adult
Aged
Autografts
Chromosome Aberrations
Disease-Free Survival
Europe
Female
Follow-Up Studies
Humans
Male
Middle Aged
Multiple Myeloma
Risk Factors
Societies, Medical
Stem Cell Transplantation
Survival Rate
English 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.
Language
  • English
Open access status
hybrid
Identifiers
Persistent URL
https://sonar.ch/global/documents/73724
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