1. Early Relapse After Autologous Transplant Is Associated With Very Poor Survival and Identifies an Ultra-High-Risk Group of Patients With Myeloma
- Author
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Nikolaos Kanellias, Dimitra Gika, Efstathios Manios, Ioannis Ntanasis-Stathopoulos, Dimitrios C. Ziogas, Stavroula Giannouli, Anastasia Gatou, Maria Gavriatopoulou, Maria Roussou, Despina Fotiou, Meletios A. Dimopoulos, Despoina Mparmparousi, Magdalini Migkou, Evangelos Eleutherakis-Papaiakovou, Panagiotis Tsirigotis, Efstathios Kastritis, Despina Katopi, Michail Liontos, and Evangelos Terpos
- Subjects
Adult ,Male ,Oncology ,Cancer Research ,medicine.medical_specialty ,Multivariate analysis ,Early Relapse ,Ultra high risk ,Single Center ,Transplantation, Autologous ,Cytogenetics ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Autologous stem-cell transplantation ,Risk Factors ,Internal medicine ,Humans ,Medicine ,Autologous transplant ,Aged ,Retrospective Studies ,business.industry ,Hazard ratio ,Hematology ,Middle Aged ,030220 oncology & carcinogenesis ,Female ,Multiple Myeloma ,business ,030215 immunology - Abstract
Patients relapsing early after autologous stem cell transplantation (ASCT) are a particular therapeutic challenge.This was a retrospective, single center study that included 297 consecutive patients that received first-line ASCT RESULTS: We identified 43 (14.5%) patients that relapsed within12 months. At diagnosis, these patients had more often elevated lactate dehydrogenase, lower estimated glomerular filtration rate, hypercalcemia, and high-risk cytogenetics; the International Staging System stage distribution was similar. Consolidation and maintenance were associated with lower rates of early relapses. Progression-free survival to second-line therapy was 5 months versus 19 months for those with an early versus late relapse (P .001), the median PFS to second-line therapy was 15.5 months versus5 years (P .001) and the median post-ASCT survival was 18 months versus6 years. The survival after an early relapse has not improved significantly over time. In multivariate analysis, early relapse (hazard ratio, 14; P .001) was the most important prognostic factor for poor survival after ASCT.Patients relapsing12 months after ASCT comprise an ultra-high-risk group, with poor outcomes even with the application of the more recent combinations, that urgently needs more effective therapies.
- Published
- 2020