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Autologous stem cell transplantation in multiple myeloma patients: utilization patterns and hospital effects
Jansen, L., Merz, M., Engelhardt, M., Weisel, K., Scheid, C., Straka, C., Langer, C., Salwender, H., Einsele, H., Kroger, N., et al
Leukemia & lymphoma. 2020;:1-10
Abstract
Evidence on volume outcome associations for autologous stem cell transplantation (ASCT) in multiple myeloma (MM) is limited. We investigated ASCT utilization patterns and volume outcome associations in the German National Registry for Stem Cell Transplants (DRST). MM patients with an upfront ASCT between 1998 and 2014 registered in the DRST were included. ASCT utilization increased strongly from 6% to 17% between 1999 and 2013 with the largest increase for patients aged 60-64 years (8-34%). The mean number of ASCTs conducted in the hospitals per year varied (quintiles, Q1:0.0-8.2 to Q5:31.0-102.7). Center volume was not associated with survival after upfront ASCT (lowest vs. highest center volume, hazard ratios and 95% confidence intervals: 0.95 (0.76-1.18), p = 0.92). Our findings may reflect a high standard of care and degree of specialization of centers performing ASCT for MM in Germany.
2.
The Outcome of Haplo-Identical Transplantation in Patients with Relapsed Multiple Myeloma: An EBMT/CIBMTR Report
Sahebi, F., Garderet, L., Kanate, A. S., Eikema, D. J., Knelange, N. S., Alvelo, O. F. D., Koc, Y., Blaise, D., Bashir, Q., Moraleda, J. M., et al
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2018
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Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) using siblings and matched donors has the potential for long-term disease control in a subset of high-risk multiple myeloma (MM) patients. However, the data on using haploidentical donors in this disease are limited. We conducted a retrospective analysis to examine the outcomes of patients with MM who underwent haploidentical allo-HCT within EBMT/CIBMTR centers. A total of 96 patients underwent haploidentical transplantation between 2008 and 2016. With a median follow up of 24.0 months (range, 13.2-24.9 months), 97% (95%CI, 93%-100%) of patients had neutrophil engraftment by day 28, and 75% (95%CI, 66%-84%) achieved platelet recovery by day 60. Two-year progression-free survival (PFS) was 17% (95%CI, 8%-26%), and overall survival (OS) was 48% (95%CI, 36%-59%). At 2 years, the cumulative risk of relapse/progression was 56% (95%CI, 45%-67%), and 1-year non-relapse mortality (NRM) was 21% (95%CI, 13%-29%). The incidence of acute graft-versus-host-disease (GVHD) grades II-IV by 100 days and chronic GVHD at 2 years were 39% (95%CI, 28%-49%) and 46% (95%CI, 34%-59%), respectively. On univariate analysis, use of post-transplant cyclophosphamide (PT-Cy) (54% [95%CI, 41%-68%] vs 25% [95%CI, 1%-48%], p=0.009), and use of bone marrow as source of stem cells (72% [95%CI, 55%-89%] vs 31% [95%CI, 17%-46%], p=0.001), were associated with improved OS at 2 years. Disease status, patient gender, intensity of conditioning regimen, recipient/donor gender mismatch, and CMV status had no impact on OS, PFS, or NRM. Haploidentical transplantation is feasible for patients with multiply relapsed or high-risk MM, with an encouraging 2-year OS of 48% and an NRM rate of 21% at 1 year, supporting further investigation of haploidentical transplantation in suitable candidates with MM.
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Survival of elderly patients with multiple myeloma-Effect of upfront autologous stem cell transplantation
Merz, M., Jansen, L., Castro, F. A., Hillengass, J., Salwender, H., Weisel, K., Scheid, C., Luttmann, S., Emrich, K., Holleczek, B., et al
European Journal of Cancer. 2016;62:1-8
Abstract
BACKGROUND The aim of this study was to determine the value of upfront autologous transplantation (ASCT) in elderly patients (60-79 years) with myeloma. METHODS We analysed relative survival (RS) of patients diagnosed in 1998-2011 and treated with ASCT within 12 months after diagnosis in Germany (n = 3591; German Registry of Stem Cell Transplantation) and compare RS with survival of myeloma patients diagnosed in the same years in Germany (n = 13,903; population-based German Cancer Registries). RESULTS Utilisation of ASCT has increased rapidly between 2000-2002 and 2009-2011 (60-64years: 7.0-43.0%; 65-69 years: 6.6-23.7%; 70-79 years: 0.4-4.0%). Comparison of 5-year RS of patients from the general German myeloma population who have survived the first year after diagnosis with 5-year RS of patients treated with ASCT revealed higher survival for transplanted patients among all age groups (60-64: 59.2% versus 66.1%; 65-69: 57.4% versus 61.7%; 70-79: 51.0% versus 56.6%). RS increased strongly between 2003-2005 and 2009-2011 for the general German myeloma population (+8.5%) and for patients treated with ASCT (+11.8%). Differences in RS between these groups increased over time from +1.9% higher age-standardised survival in transplanted patients in 2003-2005 to 5.2% higher survival in 2009-2011. CONCLUSION We conclude that upfront ASCT might be a major contributor to improved survival for elderly myeloma patients in Germany.