1. Tandem Autologous-Autologous versus Autologous-Allogeneic Hematopoietic Stem Cell Transplant for Patients with Multiple Myeloma: Long-Term Follow-Up Results from the Blood and Marrow Transplant Clinical Trials Network 0102 Trial.
- Author
-
Giralt, Sergio, Costa, Luciano J., Maloney, David, Krishnan, Amrita, Fei, Mingwei, Antin, Joseph H., Brunstein, Claudio, Geller, Nancy, Goodman, Stacey, Hari, Parameswaran, Logan, Brent, Lowsky, Robert, Qazilbash, Muzaffar H., Sahebi, Firoozeh, Somlo, George, Rowley, Scott, Vogl, Dan T., Vesole, David H., Pasquini, Marcelo, and Stadtmauer, Edward
- Subjects
- *
STEM cell transplantation , *MULTIPLE myeloma , *AUTOGRAFTS , *HEMATOPOIETIC stem cells , *CLINICAL trials , *BONE marrow - Abstract
• Long-term follow-up of auto-auto versus auto-allo in newly diagnosed multiple myeloma patients confirms significant and durable reduction in risk of relapse with the auto-allo approach. • Auto-allo transplant is associated with better 6-year PFS for high-risk patients. • Patients who relapsed after auto-allo had longer postrelapse survival than patients who relapsed after auto-auto transplant. Allogeneic hematopoietic cell transplant (HCT) may improve long-term multiple myeloma (MM) control through the graft-versus-myeloma effect. The Blood and Marrow Transplant Clinical Trials Network 0102 trial was a biologic assignment trial comparing tandem autologous transplant (auto-auto) versus autologous followed by reduced-intensity allogeneic (auto-allo) transplant in patients with newly diagnosed MM with standard-risk (n = 625) or high-risk (n = 85; β 2 -microglobulin at diagnosis ≥ 4 mg/dL or deletion of chromosome 13 by conventional karyotyping) disease. Although the initial 3-year analysis showed no difference in progression-free survival (PFS) between arms in either risk group, we hypothesized that long-term follow-up may better capture the impact of the graft-versus-myeloma effect. Median follow-up of survivors was over 10 years. Among standard-risk patients there was no difference in PFS (hazard ratio [HR], 1.11; 95% confidence interval [CI],.93 to 1.35; P =.25) or OS (HR, 1.03; 95% CI,.82 to 1.28; P =.82). The 6-year PFS was 25% in the auto-auto arm versus 22% in the auto-allo arm (P =.32), and 6-year overall survival (OS) was 60% and 59%, respectively (P =.85). In the high-risk group, although there was no statistically significant difference in PFS (HR,.66; 95% CI,.41 to 1.07; P =.07) and OS (HR, 1.01; 95% CI,.60 to 1.71; P =.96), a reduction in 6-year risk of relapse of 77% versus 47% (P =.005) was reflected in better PFS of 13% versus 31% (P =.05) but similar OS, at 47% versus 51% (P =.69). Allogeneic HCT can lead to long-term disease control in patients with high-risk MM and needs to be explored in the context of modern therapy. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF