BACKGROUND: High-dose chemotherapy with autologous hematopoietic cell transplant (auto-HCT) has been shown to improve survival in patients with newly diagnosed multiple myeloma. However, the role of salvage auto-HCT for relapsed patients, particularly in the era of novel therapeutics, is not well defined. METHODS: The authors performed a retrospective analysis of all 44 myeloma patients (24 men, 20 women) who received a second auto-HCT as salvage between January 3, 1992 and November 4, 2008 at The University of Texas MD Anderson Cancer Center. RESULTS: Median interval between the first and salvage auto-HCT was 30 months (range, 2-78 months). Median age at salvage HCT was 54 years (range, 38-73 years), and median number of salvage treatment regimens was 2 (range, 0-5). Eleven (25%) patients had high-risk chromosomal abnormalities on conventional cytogenetic studies between diagnosis and salvage auto-HCT. Ten patients (23%) experienced grade 3 or higher nonhematologic toxicity after the salvage auto-HCT. One patient died within 100 days, for a treatment-related mortality of 2%. Best responses after salvage chemotherapy + salvage auto-HCT were as follows: complete response (CR) + near CR, 11%; partial response, 79%; overall response rate, 90%. Eighteen (41%) patients received post auto-HCT maintenance therapy. Median follow-up from salvage HCT was 41 months. Kaplan-Meier estimates of median progression-free survival (PFS) and overall survival (OS) from time of salvage auto-HCT were 12.3 and 31.7 months, respectively. Median OS from the time of diagnosis was 75 months. In a fitted Bayesian multivariate model, shorter time to progression after first auto-HCT, greater number of prior therapies, African American race, and immunoglobulin G subtype were significantly associated with worse OS. CONCLUSIONS: In selected myeloma patients, a second auto-HCT for salvage therapy is well tolerated, with acceptable toxicity. The overall response rate and PFS are comparable to other salvage regimens.
BACKGROUND: High-dose chemotherapy with autologous hematopoietic cell transplant (auto-HCT) has been shown to improve survival in patients with newly diagnosed multiple myeloma. However, the role of salvage auto-HCT for relapsed patients, particularly in the era of novel therapeutics, is not well defined. METHODS: The authors performed a retrospective analysis of all 44 myelomapatients (24 men, 20 women) who received a second auto-HCT as salvage between January 3, 1992 and November 4, 2008 at The University of Texas MD Anderson Cancer Center. RESULTS: Median interval between the first and salvage auto-HCT was 30 months (range, 2-78 months). Median age at salvage HCT was 54 years (range, 38-73 years), and median number of salvage treatment regimens was 2 (range, 0-5). Eleven (25%) patients had high-risk chromosomal abnormalities on conventional cytogenetic studies between diagnosis and salvage auto-HCT. Ten patients (23%) experienced grade 3 or higher nonhematologic toxicity after the salvage auto-HCT. One patient died within 100 days, for a treatment-related mortality of 2%. Best responses after salvage chemotherapy + salvage auto-HCT were as follows: complete response (CR) + near CR, 11%; partial response, 79%; overall response rate, 90%. Eighteen (41%) patients received post auto-HCT maintenance therapy. Median follow-up from salvage HCT was 41 months. Kaplan-Meier estimates of median progression-free survival (PFS) and overall survival (OS) from time of salvage auto-HCT were 12.3 and 31.7 months, respectively. Median OS from the time of diagnosis was 75 months. In a fitted Bayesian multivariate model, shorter time to progression after first auto-HCT, greater number of prior therapies, African American race, and immunoglobulin G subtype were significantly associated with worse OS. CONCLUSIONS: In selected myelomapatients, a second auto-HCT for salvage therapy is well tolerated, with acceptable toxicity. The overall response rate and PFS are comparable to other salvage regimens.
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Authors: Laura C Michaelis; Ayman Saad; Xiaobo Zhong; Jennifer Le-Rademacher; Cesar O Freytes; David I Marks; Hillard M Lazarus; Jennifer M Bird; Leona Holmberg; Rammurti T Kamble; Shaji Kumar; Michael Lill; Kenneth R Meehan; Wael Saber; Jeffrey Schriber; Jason Tay; Dan T Vogl; Baldeep Wirk; Bipin N Savani; Robert P Gale; David H Vesole; Gary J Schiller; Muneer Abidi; Kenneth C Anderson; Taiga Nishihori; Matt E Kalaycio; Julie M Vose; Jan S Moreb; William Drobyski; Reinhold Munker; Vivek Roy; Armin Ghobadi; H Kent Holland; Rajneesh Nath; L Bik To; Angelo Maiolino; Adetola A Kassim; Sergio A Giralt; Heather Landau; Harry C Schouten; Richard T Maziarz; Joseph Mikhael; Tamila Kindwall-Keller; Patrick J Stiff; John Gibson; Sagar Lonial; Amrita Krishnan; Angela Dispenzieri; Parameswaran Hari Journal: Biol Blood Marrow Transplant Date: 2013-01-05 Impact factor: 5.742
Authors: Sergio Giralt; Laurent Garderet; Brian Durie; Gordon Cook; Gosta Gahrton; Benedetto Bruno; Paremesweran Hari; Henk Lokhorst; Phillip McCarthy; Amrita Krishnan; Pieter Sonneveld; Harmut Goldschmidt; Sundar Jagannath; Bart Barlogie; Maria Mateos; Peter Gimsing; Orhan Sezer; Joseph Mikhael; Jin Lu; Meletios Dimopoulos; Amitabha Mazumder; Antonio Palumbo; Rafat Abonour; Kenneth Anderson; Michel Attal; Joan Blade; Jenny Bird; Michele Cavo; Raymond Comenzo; Javier de la Rubia; Hermann Einsele; Ramon Garcia-Sanz; Jens Hillengass; Sarah Holstein; Hans Erik Johnsen; Douglas Joshua; Guenther Koehne; Shaji Kumar; Robert Kyle; Xavier Leleu; Sagar Lonial; Heinz Ludwig; Hareth Nahi; Anil Nooka; Robert Orlowski; Vincent Rajkumar; Anthony Reiman; Paul Richardson; Eloisa Riva; Jesus San Miguel; Ingemar Turreson; Saad Usmani; David Vesole; William Bensinger; Muzaffer Qazilbash; Yvonne Efebera; Mohamed Mohty; Christina Gasparreto; James Gajewski; Charles F LeMaistre; Chris Bredeson; Phillipe Moreau; Marcelo Pasquini; Nicolaus Kroeger; Edward Stadtmauer Journal: Biol Blood Marrow Transplant Date: 2015-09-30 Impact factor: 5.742
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