Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Outcomes of salvage autologous stem cell transplantation for multiple myeloma with cytopenias and exposure to novel agents

Bone Marrow Transplantation volume 52, pages 1468–1470 (2017)Cite this article

Subjects

The treatment of multiple myeloma (MM) has been revolutionized by the introduction of novel therapies. Unfortunately, the vast majority of patients eventually become refractory to these agents and suffer from cytopenias precluding clinical trial participation. The use of a second autologous stem cell transplant (ASCT) as a salvage therapy is a potential option, with median PFS ranging from 6.8 to 18 months and overall survival (OS) ranging from 20 to 55.5 months.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 However, no prior studies have included outcomes of novel agent-refractory patients or evaluated the ability of ASCT to resuscitate hematopoiesis in patients with cytopenias who are typically ineligible for clinical trials.

We retrospectively reviewed patients who received a salvage ASCT, defined as a second ASCT (that is, melphalan ⩾100 mg/m2 with autologous stem cell infusion) not part of planned tandem transplantation. The initial ASCT is defined as SCT1 and the salvage ASCT as SCT2. Stem cells used for SCT were those remaining in storage after initial stem cell collection and SCT1. Consolidation post SCT2 was not used. PFS and OS curves from time of SCT2 were calculated using the Kaplan–Meier method. Multivariable Cox proportional hazards regression was used to identify prognostic factors for OS and PFS.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Alvares CL, Davies FE, Horton C, Patel G, Powles R, Morgan GJ . The role of second autografts in the management of myeloma at first relapse. Haematologica 2006; 91: 141–142.

    Google Scholar 

  2. Cook G, Liakopoulou E, Pearce R, Cavet J, Morgan GJ, Kirkland K et al. Factors influencing the outcome of a second autologous stem cell transplant (ASCT) in relapsed multiple myeloma: a study from the British Society of Blood and Marrow Transplantation Registry. Biol Blood Marrow Transplant 2011; 17: 1638–1645.

    Article  PubMed  Google Scholar 

  3. Fenk R, Liese V, Neubauer F, Bruns I, Kondakci M, Balleisen S et al. Predictive factors for successful salvage high-dose therapy in patients with multiple myeloma relapsing after autologous blood stem cell transplantation. Leuk Lymphoma 2011; 52: 1455–1462.

    Article  CAS  PubMed  Google Scholar 

  4. Shah N, Ahmed F, Bashir Q, Qureshi S, Dinh Y, Rondon G et al. Durable remission with salvage second autotransplants in patients with multiple myeloma. Cancer 2012; 118: 3549–3555.

    Article  PubMed  Google Scholar 

  5. Silva Rondon C, Hassoun H, Chimento D, Jia X, Giralt S, Landau HJ . Outcomes following salvage autologous stem cell transplant (Sct) for multiple myeloma. Biol Blood Marrow Transplant 2012; 18: S254.

    Article  Google Scholar 

  6. Jimenez-Zepeda VH, Mikhael J, Winter A, Franke N, Masih-Khan E, Trudel S et al. Second autologous stem cell transplantation as salvage therapy for multiple myeloma: impact on progression-free and overall survival. Biol Blood Marrow Transplant 2012; 18: 773–779.

    Article  PubMed  Google Scholar 

  7. Sellner L, Heiss C, Benner A, Raab MS, Hillengass J, Hose D et al. Autologous retransplantation for patients with recurrent multiple myeloma: a single-center experience with 200 patients. Cancer 2013; 119: 2438–2446.

    Article  CAS  PubMed  Google Scholar 

  8. Auner HW, Szydlo R, Rone A, Chaidos A, Giles C, Kanfer E et al. Salvage autologous stem cell transplantation for multiple myeloma relapsing or progressing after up-front autologous transplantation. Leuk Lymphoma 2013; 54: 2200–2204.

    Article  PubMed  Google Scholar 

  9. Michaelis LC, Saad A, Zhong X, Le-Rademacher J, Freytes CO, Marks DI et al. Salvage second hematopoietic cell transplantation in myeloma. Biol Blood Marrow Transplant 2013; 19: 760–766.

    Article  PubMed  Google Scholar 

  10. Gonsalves WI, Gertz MA, Lacy MQ, Dispenzieri A, Hayman SR, Buadi FK et al. Second auto-SCT for treatment of relapsed multiple myeloma. Bone Marrow Transplantation 2013; 48: 568–573.

    Article  CAS  PubMed  Google Scholar 

  11. Yhim HY, Kim K, Kim JS, Kang HJ, Kim JA, Min CK et al. Matched-pair analysis to compare the outcomes of a second salvage auto-SCT to systemic chemotherapy alone in patients with multiple myeloma who relapsed after front-line auto-SCT. Bone Marrow Transplant 2013; 48: 425–432.

    Article  CAS  PubMed  Google Scholar 

  12. Singh Abbi KK, Zheng J, Devlin SM, Giralt S, Landau H . Second autologous stem cell transplant: an effective therapy for relapsed multiple myeloma. Biol Blood Marrow Transplant 2015; 21: 468–472.

    Article  PubMed  Google Scholar 

  13. Grovdal M, Nahi H, Gahrton G, Liwing J, Waage A, Abildgaard N et al. Autologous stem cell transplantation versus novel drugs or conventional chemotherapy for patients with relapsed multiple myeloma after previous ASCT. Bone Marrow Transplant 2015; 50: 808–812.

    Article  CAS  PubMed  Google Scholar 

  14. Kumar SK, Lee JH, Lahuerta JJ, Morgan G, Richardson PG, Crowley J et al. Risk of progression and survival in multiple myeloma relapsing after therapy with IMiDs and bortezomib: a multicenter international myeloma working group study. Leukemia 2012; 26: 149–157.

    Article  CAS  PubMed  Google Scholar 

  15. Lonial S, Weiss BM, Usmani SZ, Singhal S, Chari A, Bahlis NJ et al. Daratumumab monotherapy in patients with treatment-refractory multiple myeloma (SIRIUS): an open-label, randomised, phase 2 trial. Lancet 2016; 387: 1551–1560.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    D Tremblay, G Lancman, E Moshier, S Jagannath & A Chari

  2. Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT, USA

    N Bar

Authors
  1. D Tremblay
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G Lancman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E Moshier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N Bar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S Jagannath
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A Chari
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A Chari.

Ethics declarations

Competing interests

AC: Advisory Roles: Celgene Corporation. Honoraria; Celgene Corporation. Educational Concepts Grant, Clinical Care Outcomes. Research Funding: Novartis. SJ: Advisory Board Meetings of Celgene, BMS, Merck, Janssen, Novartis and received Honoraria. The remaining authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tremblay, D., Lancman, G., Moshier, E. et al. Outcomes of salvage autologous stem cell transplantation for multiple myeloma with cytopenias and exposure to novel agents. Bone Marrow Transplant 52, 1468–1470 (2017). https://doi.org/10.1038/bmt.2017.160

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2017.160

Search

Advanced search

Quick links