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Outcomes after delayed and second autologous stem cell transplant in patients with relapsed multiple myeloma

Bone Marrow Transplantation volume 56, pages 2664–2671 (2021)Cite this article

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Abstract

We evaluated the outcomes of 168 patients undergoing delayed or second autologous stem cell transplant (ASCT) for relapsed multiple myeloma (MM) from 2010 to 2019. Overall, 21% (n = 35) patients had received a prior transplant and 69% (n = 116) underwent transplant at first relapse. Overall, 27% patients had high-risk cytogenetics and 15% had ISS stage III disease. Stem cell collection was performed after relapse in 72% and 35% of patients received maintenance therapy. Median PFS from salvage treatment and transplant were 28 and 19 months, respectively. Median OS from salvage treatment and transplant was 69 and 55 months. Multivariate analysis revealed that ASCT in first relapse was associated with superior PFS (HR 0.63, p = 0.03) and OS (HR 0.59, p = 0.04) compared to later lines of therapy. In addition, PFS of ≥36 months with prior therapy was associated with improved PFS (HR 0.62, p = 0.04) and OS (HR 0.41, p = 0.01). Ninety-five patients underwent delayed transplant at first relapse, median PFS and OS from start of therapy was 30 and 69 months, and median OS from diagnosis was 106 months. These data may serve as a guide when counseling patients undergoing ASCT for relapsed MM and provide a benchmark in designing clinical trials of transplantation/comparative treatments for relapsed MM.

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Fig. 1: Survival analysis from start of treatment for relapsed disease in patients undergoing ASCT at first relapse or at second relapse and beyond.
Fig. 2: Survival analysis from transplant in patients undergoing ASCT at first relapse or at second relapse and beyond.
Fig. 3: Survival analysis in patients undergoing delayed ASCT at first relapse compared to a contemporaneous cohort of patients undergoing upfront ASCT.

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Acknowledgements

Stanford BMT Database Management team. SS was supported by: KL2TR003143, KL2 Mentored Career Development Program, Stanford Clinical Translational Science Award Program.

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  1. Department of Medicine, Stanford University, Stanford, CA, USA

    Christopher Lemieux, Lori S. Muffly, David J. Iberri, Juliana K. Craig, Laura J. Johnston, Robert Lowsky, Parveen Shiraz, Andrew R. Rezvani, Matthew J. Frank, Wen-Kai Weng, Everett Meyer, Judith A. Shizuru, Sally Arai, Michaela Liedtke, Robert S. Negrin, David B. Miklos & Surbhi Sidana

  2. Division of Hematology and Medical Oncology, Department of Medicine, Université Laval, Québec, QC, Canada

    Christopher Lemieux

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SS: consultancy: Janssen; Research support: Janssen, Allogene, and Magenta Therapeutics. AR: Research Support, Pharmacyclics; one-time advisory boards for Nohla and Kaleido; expert witness, US Department of Justice; brother employed by Johnson & Johnson.

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Lemieux, C., Muffly, L.S., Iberri, D.J. et al. Outcomes after delayed and second autologous stem cell transplant in patients with relapsed multiple myeloma. Bone Marrow Transplant 56, 2664–2671 (2021). https://doi.org/10.1038/s41409-021-01371-1

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