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Salvage Autologous Hematopoietic Stem Cell Transplantation Versus Chemoimmunotherapy in Relapsed Multiple Myeloma Patients After First Transplantation; Single Center Data

Yıl 2023, Cilt: 76 Sayı: 3, 200 - 205, 24.10.2023

Ferda Can

Öz

Objectives: Multiple myeloma (MM) is an uncurable disease and standard therapy for relapsed MM is still not clear. We aimed to compare salvagetreatments for relapsed refractory MM.

Materials and Methods: Sixty patients who relapsed after first autologous stem cell transplantation (ASCT) were analyzed. Twenty-seven patients were treated with salvage chemoimmunotherapy (CIT). Thirty-three were treated with salvage ASCT.

Results: There was no difference between treatment arms in terms of gender, age and disease characteristics. Median progression-free survival (PFS) was significantly better in ASCT group than CIT group (25 months vs. 12 months; p=0.01). PFS rates on the first and second year were also better in ASCT group. Median overall survival in ASCT group was longer than CIT (73 vs. 30 months), although it did not reach a statistical significance (p=0.09). Time to achieving the best response after ASCT and CIT was 1 (0-9) month versus 6.5 (2-15) months (p=0.02). All grade toxicities were similar in both groups (ASCT 57.6% vs. CIT 48.1%) (p=0.6). Grade 3 or 4 toxicities were similar (ASCT 19%, CIT 13%) in both groups (p=0.4). In the approximate cost analysis made with current pricing in December 2022 in our country, ASCT was more economical than CIT (380 600 € vs. 393 860 €).

Conclusion: Salvage ASCT may provide longer PFS with similar toxicity profile and more cost-effective therapy profile than salvage CIT. It is
suggested that earlier and better responses, long-term PFS can be achieved with salvage ASCT.

Anahtar Kelimeler

Multiple Myeloma Relapsed Salvage Transplantation Chemoimmunotherapy Second Autologous Stem Cell Transplantation

Etik Beyan

Ethics Committee Approval: Ethics Committee approval was received from Gazi University with the number 77082166- 302.08.01. Informed Consent: Retrospective study. Peer-review: Externally and internally peer-reviewed.

Destekleyen Kurum

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Proje Numarası

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Teşekkür

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Kaynakça

  • 1. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022. CA Cancer J Clin. 2022;72:7-33.
  • 2. Cowan AJ, Allen C, Barac A, et al. Global Burden of Multiple Myeloma: A Systematic Analysis for the Global Burden of Disease Study 2016. JAMA Oncol. 2018;4:1221-1227.
  • 3. Blocka J, Hielscher T, Mueller-Tidow C, et al. Salvage therapy versus upfront autologous stem cell transplantation in multiple myeloma patients with progressive disease after first-line induction therapy. Leuk Lymphoma. 2020;61:27-36.
  • 4. Poczta A, Rogalska A, Marczak A. Treatment of Multiple Myeloma and the Role of Melphalan in the Era of Modern Therapies-Current Research and Clinical Approaches. J Clin Med. 2021;10:1841.
  • 5. Cavo M, Gay F, Beksac M, et al. Autologous haematopoietic stem-cell transplantation versus bortezomib-melphalan-prednisone, with or without bortezomib-lenalidomide-dexamethasone consolidation therapy, and lenalidomide maintenance for newly diagnosed multiple myeloma (EMN02/HO95): a multicentre, randomised, open-label, phase 3 study. Lancet Haematol. 2020;7:456-468.
  • 6. Gentile M, Morabito F, Martino M, et al. Chemotherapy-based regimens inmultiple myeloma in 2020. Panminerva Med. 2021;63:7-12.
  • 7. Blimark CH, Turesson I, Genell A, et al. Outcome and survival of myelomapatients diagnosed 2008-2015. Real-world data on 4904 patients from the Swedish Myeloma Registry. Haematologica. 2018;103:506-513.
  • 8. Bygrave CA, Pawlyn C, Davies FE, et al. Progression Free Survival below 12 Months Following Stem Cell Transplant Is a Hallmark of High-Risk Myeloma Which Is Associated with Inferior Overall Survival — Data fromthe Ukmrc Myeloma XI Trial. Blood. 2018;132:122.
  • 9. Goldschmidt H, Baertsch MA, Schlenzka J, et al. Salvage autologous transplant and lenalidomide maintenance vs. lenalidomide/dexamethasone for relapsed multiple myeloma: the randomized GMMG phase III trial ReLApsE. Leukemia. 2021;35:1134-1144.
  • 10. Dhakal B, D’Souza A, Kleman A, et al. Salvage second transplantation in relapsed multiple myeloma. Leukemia. 2021;35:1214-1217.
  • 11. Touzeau C, Quignot N, Meng J, et al. Survival and treatment patterns ofpatients with relapsed or refractory multiple myeloma in France - a cohortstudy using the French National Healthcare database (SNDS). Ann Hematol. 2021;100:1825-1836.
  • 12. Giralt S, Garderet L, Durie B, et al. American Society of Blood and Marrow Transplantation, European Society of Blood and Marrow Transplantation, Blood and Marrow Transplant Clinical Trials Network, and International Myeloma Working Group Consensus Conference on Salvage HematopoieticCell Transplantation in Patients with Relapsed Multiple Myeloma. Biol Blood Marrow Transplant. 2015;21:2039-2051.
  • 13. Duarte RF, Labopin M, Bader P, et al. Indications for haematopoietic stem cell transplantation for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2019. Bone MarrowTransplant. 2019;54:1525-1552.
  • 14. Hussein MJ, Usmani ZS. Hematopoietic Cell Transplantation in Patients With Multiple Myeloma. In: Bashir Q, Hamadani M, eds. Hematopoietic Cell Transplantation for Malignant Conditions, 1st ed. United States: Elsevier. 2019:248-249.
  • 15. Grövdal M, Nahi H, Gahrton G, et al. Autologous stem cell transplantation versus novel drugs or conventional chemotherapy for patients with relapsed multiple myeloma after previous ASCT. Bone Marrow Transplant. 2015;50:808-812.
  • 16. Michaelis LC, Saad A, Zhong X, et al. Salvage second hematopoietic cell transplantation in myeloma. Biol Blood Marrow Transplant. 2013;19:760- 766.
  • 17. Hagen PA, Stiff P. The Role of Salvage Second Autologous Hematopoietic Cell Transplantation in Relapsed Multiple Myeloma. Biol Blood Marrow Transplant. 2019;25:98-107.
  • 18. Sellner L, Heiss C, Benner A, et al. Autologous retransplantation for patients with recurrent multiple myeloma: a single-center experience with 200 patients. Cancer. 2013;119:2438-2446.
  • 19. Jimenez-Zepeda VH, Mikhael J, Winter A, et al. Second autologous stem cell transplantation as salvage therapy for multiple myeloma: impact on progression-free and overall survival. Biol Blood Marrow Transplant. 2012;18:773-739.
  • 20. Muta T, Miyamoto T, Kamimura T, et al. Significance of Salvage Autologous Stem Cell Transplantation for Relapsed Multiple Myeloma: A Nationwide Retrospective Study in Japan. Acta Haematol. 2018;139:35-44.
  • 21. Cook G, Ashcroft AJ, Cairns DA, et al. The effect of salvage autologous stemcelltransplantation on overall survival in patients with relapsed multiple myeloma (final results from BSBMT/UKMF Myeloma X Relapse [Intensive]): a randomised, open-label, phase 3 trial. The Lancet Haematology. 2016;3:340-351.
  • 22. Malkan UY, Demiroglu H, Buyukasik Y, et al. Comparison of single and double autologous stem cell transplantation in multiple myeloma patients. Open Med (Wars). 2021;16:192-197.

Yıl 2023, Cilt: 76 Sayı: 3, 200 - 205, 24.10.2023

Ferda Can

Öz

Proje Numarası

-

Kaynakça

  • 1. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022. CA Cancer J Clin. 2022;72:7-33.
  • 2. Cowan AJ, Allen C, Barac A, et al. Global Burden of Multiple Myeloma: A Systematic Analysis for the Global Burden of Disease Study 2016. JAMA Oncol. 2018;4:1221-1227.
  • 3. Blocka J, Hielscher T, Mueller-Tidow C, et al. Salvage therapy versus upfront autologous stem cell transplantation in multiple myeloma patients with progressive disease after first-line induction therapy. Leuk Lymphoma. 2020;61:27-36.
  • 4. Poczta A, Rogalska A, Marczak A. Treatment of Multiple Myeloma and the Role of Melphalan in the Era of Modern Therapies-Current Research and Clinical Approaches. J Clin Med. 2021;10:1841.
  • 5. Cavo M, Gay F, Beksac M, et al. Autologous haematopoietic stem-cell transplantation versus bortezomib-melphalan-prednisone, with or without bortezomib-lenalidomide-dexamethasone consolidation therapy, and lenalidomide maintenance for newly diagnosed multiple myeloma (EMN02/HO95): a multicentre, randomised, open-label, phase 3 study. Lancet Haematol. 2020;7:456-468.
  • 6. Gentile M, Morabito F, Martino M, et al. Chemotherapy-based regimens inmultiple myeloma in 2020. Panminerva Med. 2021;63:7-12.
  • 7. Blimark CH, Turesson I, Genell A, et al. Outcome and survival of myelomapatients diagnosed 2008-2015. Real-world data on 4904 patients from the Swedish Myeloma Registry. Haematologica. 2018;103:506-513.
  • 8. Bygrave CA, Pawlyn C, Davies FE, et al. Progression Free Survival below 12 Months Following Stem Cell Transplant Is a Hallmark of High-Risk Myeloma Which Is Associated with Inferior Overall Survival — Data fromthe Ukmrc Myeloma XI Trial. Blood. 2018;132:122.
  • 9. Goldschmidt H, Baertsch MA, Schlenzka J, et al. Salvage autologous transplant and lenalidomide maintenance vs. lenalidomide/dexamethasone for relapsed multiple myeloma: the randomized GMMG phase III trial ReLApsE. Leukemia. 2021;35:1134-1144.
  • 10. Dhakal B, D’Souza A, Kleman A, et al. Salvage second transplantation in relapsed multiple myeloma. Leukemia. 2021;35:1214-1217.
  • 11. Touzeau C, Quignot N, Meng J, et al. Survival and treatment patterns ofpatients with relapsed or refractory multiple myeloma in France - a cohortstudy using the French National Healthcare database (SNDS). Ann Hematol. 2021;100:1825-1836.
  • 12. Giralt S, Garderet L, Durie B, et al. American Society of Blood and Marrow Transplantation, European Society of Blood and Marrow Transplantation, Blood and Marrow Transplant Clinical Trials Network, and International Myeloma Working Group Consensus Conference on Salvage HematopoieticCell Transplantation in Patients with Relapsed Multiple Myeloma. Biol Blood Marrow Transplant. 2015;21:2039-2051.
  • 13. Duarte RF, Labopin M, Bader P, et al. Indications for haematopoietic stem cell transplantation for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2019. Bone MarrowTransplant. 2019;54:1525-1552.
  • 14. Hussein MJ, Usmani ZS. Hematopoietic Cell Transplantation in Patients With Multiple Myeloma. In: Bashir Q, Hamadani M, eds. Hematopoietic Cell Transplantation for Malignant Conditions, 1st ed. United States: Elsevier. 2019:248-249.
  • 15. Grövdal M, Nahi H, Gahrton G, et al. Autologous stem cell transplantation versus novel drugs or conventional chemotherapy for patients with relapsed multiple myeloma after previous ASCT. Bone Marrow Transplant. 2015;50:808-812.
  • 16. Michaelis LC, Saad A, Zhong X, et al. Salvage second hematopoietic cell transplantation in myeloma. Biol Blood Marrow Transplant. 2013;19:760- 766.
  • 17. Hagen PA, Stiff P. The Role of Salvage Second Autologous Hematopoietic Cell Transplantation in Relapsed Multiple Myeloma. Biol Blood Marrow Transplant. 2019;25:98-107.
  • 18. Sellner L, Heiss C, Benner A, et al. Autologous retransplantation for patients with recurrent multiple myeloma: a single-center experience with 200 patients. Cancer. 2013;119:2438-2446.
  • 19. Jimenez-Zepeda VH, Mikhael J, Winter A, et al. Second autologous stem cell transplantation as salvage therapy for multiple myeloma: impact on progression-free and overall survival. Biol Blood Marrow Transplant. 2012;18:773-739.
  • 20. Muta T, Miyamoto T, Kamimura T, et al. Significance of Salvage Autologous Stem Cell Transplantation for Relapsed Multiple Myeloma: A Nationwide Retrospective Study in Japan. Acta Haematol. 2018;139:35-44.
  • 21. Cook G, Ashcroft AJ, Cairns DA, et al. The effect of salvage autologous stemcelltransplantation on overall survival in patients with relapsed multiple myeloma (final results from BSBMT/UKMF Myeloma X Relapse [Intensive]): a randomised, open-label, phase 3 trial. The Lancet Haematology. 2016;3:340-351.
  • 22. Malkan UY, Demiroglu H, Buyukasik Y, et al. Comparison of single and double autologous stem cell transplantation in multiple myeloma patients. Open Med (Wars). 2021;16:192-197.
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Hematoloji
Bölüm Makaleler
Yazarlar

Ferda Can 0000-0002-9899-1441

Proje Numarası -
Yayımlanma Tarihi 24 Ekim 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 76 Sayı: 3

Kaynak Göster

APA Can, F. (2023). Salvage Autologous Hematopoietic Stem Cell Transplantation Versus Chemoimmunotherapy in Relapsed Multiple Myeloma Patients After First Transplantation; Single Center Data. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 76(3), 200-205. https://doi.org/10.4274/atfm.galenos.2023.83713
AMA Can F. Salvage Autologous Hematopoietic Stem Cell Transplantation Versus Chemoimmunotherapy in Relapsed Multiple Myeloma Patients After First Transplantation; Single Center Data. Ankara Üniversitesi Tıp Fakültesi Mecmuası. Ekim 2023;76(3):200-205. doi:10.4274/atfm.galenos.2023.83713
Chicago Can, Ferda. “Salvage Autologous Hematopoietic Stem Cell Transplantation Versus Chemoimmunotherapy in Relapsed Multiple Myeloma Patients After First Transplantation; Single Center Data”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 76, sy. 3 (Ekim 2023): 200-205. https://doi.org/10.4274/atfm.galenos.2023.83713.
EndNote Can F (01 Ekim 2023) Salvage Autologous Hematopoietic Stem Cell Transplantation Versus Chemoimmunotherapy in Relapsed Multiple Myeloma Patients After First Transplantation; Single Center Data. Ankara Üniversitesi Tıp Fakültesi Mecmuası 76 3 200–205.
IEEE F. Can, “Salvage Autologous Hematopoietic Stem Cell Transplantation Versus Chemoimmunotherapy in Relapsed Multiple Myeloma Patients After First Transplantation; Single Center Data”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 76, sy. 3, ss. 200–205, 2023, doi: 10.4274/atfm.galenos.2023.83713.
ISNAD Can, Ferda. “Salvage Autologous Hematopoietic Stem Cell Transplantation Versus Chemoimmunotherapy in Relapsed Multiple Myeloma Patients After First Transplantation; Single Center Data”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 76/3 (Ekim 2023), 200-205. https://doi.org/10.4274/atfm.galenos.2023.83713.
JAMA Can F. Salvage Autologous Hematopoietic Stem Cell Transplantation Versus Chemoimmunotherapy in Relapsed Multiple Myeloma Patients After First Transplantation; Single Center Data. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2023;76:200–205.
MLA Can, Ferda. “Salvage Autologous Hematopoietic Stem Cell Transplantation Versus Chemoimmunotherapy in Relapsed Multiple Myeloma Patients After First Transplantation; Single Center Data”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 76, sy. 3, 2023, ss. 200-5, doi:10.4274/atfm.galenos.2023.83713.
Vancouver Can F. Salvage Autologous Hematopoietic Stem Cell Transplantation Versus Chemoimmunotherapy in Relapsed Multiple Myeloma Patients After First Transplantation; Single Center Data. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2023;76(3):200-5.
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