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Background: Autologous stem cell transplantation (auto-SCT) is a widely used treatment option in multiple myeloma (MM) patients. The optimal graft cellular composition is not known. Study design and methods: Autograft cellular composition was analyzed after freezing by flow cytometry in 127 MM patients participating in a prospective multicenter study. The impact of graft cellular composition on hematologic recovery and outcome after auto-SCT was evaluated. Results: A higher graft CD34⁺ cell content predicted faster platelet recovery after auto-SCT in both the short and long term. In patients with standard-risk cytogenetics, a higher graft CD34⁺ count (0.065 × 10⁶/kg, p = 0.009) and NK cell count (%gt;2.5 × 10⁶/kg, p = 0.026), lenalidomide maintenance and standard-risk cytogenetics predicted better PFS. In contrast, a higher CD34+ count (>2.5 × 10⁶/kg, p = 0.015) predicted worse PFS. A very low CD3⁺ cell count (≤20 × 10⁶/kg, p = 0.001) in the infused graft and high-risk cytogenetics remained predictive of worse OS. Conclusions: Autograft cellular composition may impact outcome in MM patients after auto-SCT. More studies are needed to define optimal graft composition.

Background: Autologous stem cell transplantation is an established treatment option for patients with multiple myeloma (MM) or non‐Hodgkinʼs lymphoma (NHL). Study design and methods: In this prospective multicenter study, 147 patients with MM were compared with 136 patients with NHL regarding the mobilization and apheresis of blood CD34+ cells, cellular composition of infused blood grafts, posttransplant recovery, and outcome. Results: Multiple myeloma patients mobilized CD34+ cells more effectively (6.3 × 10⁶/kg vs. 3.9 × 10⁶/kg, p = 0.001). The proportion of poor mobilizers (peak blood CD34+ cell count 100 days) nonrelapse mortality (NRM; 6% vs. 0%, p = 0.003). Conclusions: Non‐Hodgkinʼs lymphoma and MM patients differ in terms of mobilization of CD34+ cells, graft cellular composition, and posttransplant recovery. Thus, the optimal graft characteristics may also be different.

Tiivistelmä Myeloomassa luuytimen pahanlaatuiset plasmasolut syövyttävät luustoa ja tuottavat poikkeavaa valkuaista, paraproteiinia. Myelooman hoito aloitetaan, mikäli potilaalla todetaan hyperkalsemia, munuaisvaurio, anemia tai lyyttisiä luustopesäkkeitä. Näiden kohde-elinvaurioiden lisäksi tietyt laboratorio- ja luuston kuvantamislöydökset ovat nykyään hoidon aloittamisen aihe. Kliininen taudinkuva vaihtelee paljon ja määräytyy pitkälti tautisolukon geneettisten muutosten mukaan. Vaikka laajasti käytetty autologinen kantasolusiirtohoito ja 15 viime vuoden aikana käyttöön saadut myelooman patofysiologisiin avainkohtiin vaikuttavat lääkkeet ovat parantaneet erityisesti nuorempien potilaiden ennustetta. Yksittäisten potilaiden ennuste on hyvin vaihteleva. Erityisesti suuren riskin potilaille tarvittaisiin nykyistä tehokkaampia hoitoja. Abstract Multiple myeloma is characterized by proliferation of malignant plasma cells in the bone marrow with monoclonal protein in the serum and/or urine. Active treatment of the disease is initiated when associated with specific biomarkers or end-organ damage, i.e. anemia, renal insufficiency, lytic bone lesions or hypercalcemia. Genetic background of the disease has a substantial impact on the clinical course. Although overall survival of younger patients has increased with the wide use of autologous stem cell transplantation and the introduction of novel drugs, new therapeutic strategies are needed for patients with high-risk disease.