-
1.
Trends in utilization of stored cryopreserved autologous peripheral hematopoietic cells intended for a second (or beyond) autologous hematopoietic cell transplantation in patients with multiple myeloma: a single center experience
Yassine, F., Kharfan-Dabaja, M. A., Tsalantsanis, A., Roy, V., Zubair, A. C., Murthy, H. S., Ayala, E., Iqbal, M., Sher, T., Ailawadhi, S., et al
Bone marrow transplantation. 2023
Abstract
Due to the advent of effective novel therapies for multiple myeloma (MM), the use of cryopreserved autologous peripheral blood hematopoietic cells (APBHC) for a salvage autologous transplant (auto-HCT) is in decline. We evaluated utilization trends and costs associated with cryopreserved APBHC in patients with MM. We retrospectively evaluated the clinicopathologic data from 440 patients with MM who underwent APBHC mobilization and collection at Mayo Clinic Florida between 2010 and 2019. Based on institution-specific charges as of May 2021, the cost of 1 session of APBHC collection/apheresis was $4,680 and the cost of 1 year of APBHC cryopreservation was $4,790 per patient. Out of 347 patients who had APBHC in cryopreservation, 5 (1.4%) underwent a salvage auto-HCT and 61% of patients had ≥1 excess collection sessions for APBHC that ultimately went unused. The median cost of excess collection sessions was $4,680 per patient (range, $4,680-$32,760) and the median total cost for excess collection sessions plus costs for storage was $23,840 per patient (range, $4,680-$85,450). The sum of costs of excess collection sessions was $2,077,920 and the sum of costs of cryopreservation was $5,812,665. Institutional policies regarding universal APBHC collection and long-term storage should be reevaluated in the era of novel therapeutics.
-
2.
Novel prognostic scoring system for autologous hematopoietic cell transplantation in multiple myeloma
Dhakal, B., D'Souza, A., Callander, N., Chhabra, S., Fraser, R., Davila, O., Anderson, K., Assal, A., Badawy, S. M., Berdeja, J., et al
British journal of haematology. 2020
-
-
-
Free full text
-
Full text
-
Editor's Choice
Abstract
We studied 2,528 patients with upfront autologous haematopoietic cell transplantation (AHCT) for multiple myeloma (MM) from 2008-2017 to develop a prognostic model to predict outcomes. High-risk cytogenetics included t(4;14), t(14;16), t(14;20), del13q on karyotype, del17p, +1q or 1pdel. A Cox model identified factors prognostic of progression/relapse in a training subset (n = 1,246). A weighted score using these factors was assigned to a validation cohort (n = 774). Presence of high-risk cytogenetics [hazard ratio, (HR) 1·68 (1·3-2·17)] and pre-AHCT bone marrow plasma cells (BMPCs) ≥10% [1·68 (1·33-2·12)] were assigned 4 points each; albumin at diagnosis <3·5 g/dl [1·31 (1·07-1·61)] 2; standard risk cytogenetics 1, and no cytogenetics abnormality, BMPCs <10% at AHCT and albumin ≥3·5 g/dl at diagnosis 0 points each. A three-category system with low risk (0-3), intermediate risk (4-8) and high risk (9-10) showed 3-year progression-free survival in the low vs. intermediate vs. high risk of 58% (95% CI: 52-63) vs. 49% (95% CI: 43-56) vs. 31% (95% CI: 12-51), P < 0.001 respectively, and 3-year OS in low vs. intermediate vs. high risk of 88% (95% CI: 84-91) vs. 81% (95% CI: 76-86) vs. 64% (95% CI: 39-80); P < 0·001. Our prognostic scoring system can identify MM patients at risk for early relapse after AHCT.
PICO Summary
Population
Patients with multiple myeloma (MM) undergoing upfront autologous haematopoietic transplantation (AHCT) (n=2528)
Intervention
Development of a prognostic model to predict outcomes
Comparison
Outcome
Presence of high-risk cytogenetics [hazard ratio, (HR) 1·68] and pre-AHCT bone marrow plasma cells (BMPCs) ≥10% [1·68] were assigned 4 points each; albumin at diagnosis <3·5 g/dl [1·31] 2; standard risk cytogenetics 1, and no cytogenetics abnormality, BMPCs <10% at AHCT and albumin ≥3·5 g/dl at diagnosis 0 points each. A three-category system with low risk (0-3), intermediate risk (4-8) and high risk (9-10) showed 3-year progression-free survival in the low vs. intermediate vs. high risk of 58% vs. 49% vs. 31%, and 3-year OS in low vs. intermediate vs. high risk of 88% vs. 81% vs. 64%.
-
3.
African Americans with translocation t(11;14) have superior survival after autologous hematopoietic cell transplantation for multiple myeloma in comparison with Whites in the United States
Badar, T., Hari, P., Dávila, O., Fraser, R., Wirk, B., Dhakal, B., Freytes, C. O., Rodriguez Valdes, C., Lee, C., Vesole, D. H., et al
Cancer. 2020
Abstract
BACKGROUND Multiple myeloma (MM) with the translocation t(11;14) may have inferior outcomes in comparison with other standard-risk MM, and it has been suggested to portend a worse prognosis in African Americans in comparison with Whites. This study used the Center for International Blood and Marrow Transplant Research (CIBMTR) database to examine the impact of t(11;14) on the clinical outcomes of patients with MM of African American and White descent. METHODS This study evaluated 3538 patients who underwent autologous hematopoietic cell transplantation (autoHCT) for MM from 2008 to 2016 and were reported to the CIBMTR. Patients were analyzed in 4 groups: African Americans with t(11;14) (n = 117), African Americans without t(11;14) (n = 968), Whites with t(11;14) (n = 266), and Whites without t(11;14) (n = 2187). RESULTS African Americans with t(11;14) were younger, had lower Karnofsky scores, and had more advanced stage MM with a higher Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI). Fewer African Americans with t(11;14) (21%) had a coexistent high-risk marker in comparison with Whites with t(11;14) (27%). In a multivariate analysis, race and t(11;14) had no association with progression-free survival. However, overall survival was superior among African Americans with t(11;14) in comparison with Whites with t(11;14) (hazard ratio, 0.53; 95% confidence interval, 0.30-0.93; P = .03). Survival was also associated with female sex, stage, time from diagnosis to transplant, a low HCT-CI, and receipt of maintenance. CONCLUSIONS Race may have a differential impact on the survival of patients with t(11;14) MM who undergo autoHCT and needs to be further studied.
-
4.
Age no bar: A CIBMTR analysis of elderly patients undergoing autologous hematopoietic cell transplantation for multiple myeloma
Munshi, P. N., Vesole, D., Jurczyszyn, A., Zaucha, J. M., St Martin, A., Davila, O., Agrawal, V., Badawy, S. M., Battiwalla, M., Chhabra, S., et al
Cancer. 2020
-
-
-
Free full text
-
Full text
-
Editor's Choice
Abstract
BACKGROUND Upfront autologous hematopoietic stem cell transplantation (AHCT) remains an important therapy in the management of patients with multiple myeloma (MM), a disease of older adults. METHODS The authors investigated the outcomes of AHCT in patients with MM who were aged =70 years. The Center for International Blood and Marrow Transplant Research (CIBMTR) database registered 15,999 patients with MM in the United States within 12 months of diagnosis during 2013 through 2017; a total of 2092 patients were aged =70 years. Nonrecurrence mortality (NRM), disease recurrence and/or progression (relapse; REL), progression-free survival (PFS), and overall survival (OS) were modeled using Cox proportional hazards models with age at transplantation as the main effect. Because of the large sample size, a P value <.01 was considered to be statistically significant a priori. RESULTS An increase in AHCT was noted in 2017 (28%) compared with 2013 (15%) among patients aged =70 years. Although approximately 82% of patients received melphalan (Mel) at a dose of 200 mg/m(2) overall, 58% of the patients aged =70 years received Mel at a dose of 140 mg/m(2) . On multivariate analysis, patients aged =70 years demonstrated no difference with regard to NRM (hazard ratio [HR] 1.3; 99% confidence interval [99% CI], 1-1.7 [P = .06]), REL (HR, 1.03; 99% CI, 0.9-1.1 [P = 0.6]), PFS (HR, 1.06; 99% CI, 1-1.2 [P = 0.2]), and OS (HR, 1.2; 99% CI, 1-1.4 [P = .02]) compared with the reference group (those aged 60-69 years). In patients aged =70 years, Mel administered at a dose of 140 mg/m(2) was found to be associated with worse outcomes compared with Mel administered at a dose of 200 mg/m(2) , including day 100 NRM (1% [95% CI, 1%-2%] vs 0% [95% CI, 0%-1%]; P = .003]), 2-year PFS (64% [95% CI, 60%-67%] vs 69% [95% CI, 66%-73%]; P = .003), and 2-year OS (85% [95% CI, 82%-87%] vs 89% [95% CI, 86%-91%]; P = .01]), likely representing frailty. CONCLUSIONS The results of the current study demonstrated that AHCT remains an effective consolidation therapy among patients with MM across all age groups.
PICO Summary
Population
Patients with multiple myeloma (n=2092)
Intervention
Patients 70 years and older (n=2092)
Comparison
Reference group aged 60-69 years
Outcome
An increase in AHCT was noted in 2017 (28%) compared with 2013 (15%) among patients aged >/=70 years. Although approximately 82% of patients received melphalan (Mel) at a dose of 200 mg/m(2) overall, 58% of the patients aged >/=70 years received Mel at a dose of 140 mg/m(2) . On multivariate analysis, patients aged >/=70 years demonstrated no difference with regard to NRM, REL, and OS compared with the reference group. In patients aged >=70 years, Mel administered at a dose of 140 mg/m(2) was found to be associated with worse outcomes compared with Mel administered at a dose of 200 mg/m(2) , including day 100 NRM (1% vs 0%), 2-year PFS (64% vs 69), and 2-year OS (85% vs 89%), likely representing frailty.
-
5.
Efficacy of Proteasome Inhibitor-Based Maintenance following Autologous Transplantation in Multiple Myeloma: a systematic review and meta-analysis
Parrondo, R. D., Reljic, T., Iqbal, M., Ayala, E., Kharfan-Dabaja, M. A., Kumar, A., Murthy, H. S.
European journal of haematology. 2020
Abstract
INTRODUCTION Lenalidomide maintenance, commonly prescribed in the post-autologous transplantation (AHCT) setting for multiple myeloma (MM), is associated with development of secondary primary malignancies (SPM). Proteasome inhibitor maintenance (PIM) has also been evaluated in MM. We conduct a systematic review/meta-analysis to assess the efficacy of PIM in MM. METHODS Performing a comprehensive search of the medical literature using PubMed/Medline and EMBASE on September 11, 2019, we extracted data on clinical outcomes related to benefits (OS, PFS and depth of hematologic response [DOHR]) and harms (SPM and adverse events). 2144 references were identified; three studies were eligible for inclusion. RESULTS A total of 1,760 patients were included in the analysis; 507 patients received bortezomib and 395 received ixazomib maintenance. Control arms were either placebo (n=261) or thalidomide (n=358). PIM did not improve OS (HR 0.88, 95% CI 0.73-1.05, p=0.15) but improved PFS (HR 0.77, 95% CI 0.69-0.86, p= <0.00001) and DOHR (HR 0.88, 95% CI 0.79-0.98, p=0.02) compared to control. There were no significant differences between PIM and control regarding SPM (p=NS) and =grade 3 peripheral neuropathy (PN) (p=NS). CONCLUSIONS PIM following AHCT in MM improves PFS and DOHR without an increase in development of SPM or severe PN compared to placebo/thalidomide.
-
6.
Hispanics have the lowest stem cell transplant utilization rate for autologous hematopoietic cell transplantation for multiple myeloma in the United States: A CIBMTR report
Schriber, J. R., Hari, P. N., Ahn, K. W., Fei, M., Costa, L. J., Kharfan-Dabaja, M. A., Angel-Diaz, M., Gale, R. P., Ganguly, S., Girnius, S. K., et al
Cancer. 2017;123(16):3141-3149
Abstract
BACKGROUND Race/ethnicity remains an important barrier in clinical care. The authors investigated differences in the receipt of autologous hematopoietic cell transplantation (AHCT) among patients with multiple myeloma (MM) and outcomes based on race/ethnicity in the United States. METHODS The Center for International Blood and Marrow Transplant Research database was used to identify 28,450 patients who underwent AHCT for MM from 2008 through 2014. By using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results 18 registries, the incidence of MM was calculated, and a stem cell transplantation utilization rate (STUR) was derived. Post-AHCT outcomes were analyzed among patients ages 18 to 75 years who underwent melphalan-conditioned peripheral cell grafts (N = 24,102). RESULTS The STUR increased across all groups from 2008 to 2014. The increase was substantially lower among Hispanics (range, 8.6%-16.9%) and non-Hispanic blacks (range, 12.2%-20.5%) compared with non-Hispanic whites (range, 22.6%-37.8%). There were 18,046 non-Hispanic whites, 4123 non-Hispanic blacks, and 1933 Hispanic patients. The Hispanic group was younger (P < .001). Fewer patients older than 60 years underwent transplantation among Hispanics (39%) and non-Hispanic blacks (42%) compared with non-Hispanic whites (56%). A Karnofsky score <90% and a hematopoietic cell transplantation comorbidity index score >3 were more common in non-Hispanic blacks compared with Hispanic and non-Hispanic whites (P < .001). More Hispanics (57%) versus non-Hispanic blacks (54%) and non-Hispanic whites (52%; P < .001) had stage III disease. More Hispanics (48%) versus non-Hispanic blacks (45%) and non-Hispanic whites (44%) had a very good partial response or better before transplantation (P = .005). Race/ethnicity did not impact post-AHCT outcomes. CONCLUSIONS Although the STUR increased, it remained low and was significantly lower among Hispanics followed by non-Hispanic blacks compared with non-Hispanic whites. Race/ethnicity did not impact transplantation outcomes. Efforts to increase the rates of transplantation for eligible patients who have MM, with an emphasis on groups that underuse transplantation, are warranted. Cancer 2017;123:3141-9. © 2017 American Cancer Society.