Salvage use of allogeneic hematopoietic stem cell transplantation after reduced intensity conditioning from unrelated donors in multiple myeloma. A study by the Plasma Cell Disorders subcommittee of the European Group for Blood and Marrow Transplant Chronic Malignancies Working Party

Sobh, Mohamad; Michallet, Mauricette; Dubois, Valérie; Iacobelli, Simona; Köster, Linda; Biezen, Anja van; Fégueux, Nathalie; Tabrizi, Reza; Finke, Jürgen; El-Cheikh, Jean; Schipperus, Martin R.; Meijer, Ellen; Borne, Peter von dem; Petersen, Eefke; Russell, Nigel H.; Tholouli, Eleni; Passweg, Jakob; Garban, Frédéric; Maertens, Johan; Chevalier, Patrice; Maillard, Natacha; Volin, Liisa; François, Sylvie; Lioure, Bruno; Béguin, Yves; Gluckman, Éliane; Ruggeri, Annalisa; Garderet, Laurent

doi:10.3324/haematol.2017.165399

Cited by 11 publications

(13 citation statements)

References 11 publications

(18 reference statements)

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“…Various single institutions reported that NRM varied from 11 to 26%. Recently, EBMT reported that the NRM for salvage transplantation using unrelated donors at 2 years was 22% [13]. These current results are encouraging considering that all the enrolled patients in this study underwent myeloablative conditioning regimen as salvage allo SCT.…”

supporting

confidence: 57%

Safety and efficacy of haploidentical stem cell transplantation for multiple myeloma

Chen

et al. 2018

Bone Marrow Transplant

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supporting

confidence: 57%

Safety and efficacy of haploidentical stem cell transplantation for multiple myeloma

Chen

et al. 2018

Bone Marrow Transplant

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“…In most prospective studies randomization depended on the availability of an HLA-identical donor, thus, the impact of HLA-status on survival has not been examined. In a recent evaluation of registry data, the outcome of MM-patients receiving peripheral blood stem cells of HLA-matched vs. -mismatched donors and those receiving cord blood stem cells was similar [ 54 ]. However, in a multivariate analysis of a single-center study transplantation from a HLA-mismatched donor was a predictor of reduced survival after allo-SCT [ 55 ].…”

Section: Conditioning Therapymentioning

confidence: 99%

Allogeneic Stem Cell Transplantation in Multiple Myeloma

Greil

Engelhardt

Finke

et al. 2021

Cancers

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The development of new inhibitory and immunological agents and combination therapies significantly improved response rates and survival of patients diagnosed with multiple myeloma (MM) in the last decade, but the disease is still considered to be incurable by current standards and the prognosis is dismal especially in high-risk groups and in relapsed and/or refractory patients. Allogeneic hematopoietic stem cell transplantation (allo-SCT) may enable long-term survival and even cure for individual patients via an immune-mediated graft-versus-myeloma (GvM) effect, but remains controversial due to relevant transplant-related risks, particularly immunosuppression and graft-versus-host disease, and a substantial non-relapse mortality. The decreased risk of disease progression may outweigh this treatment-related toxicity for young, fit patients in high-risk constellations with otherwise often poor long-term prognosis. Here, allo-SCT should be considered within clinical trials in first-line as part of a tandem approach to separate myeloablation achieved by high-dose chemotherapy with autologous SCT, and following allo-SCT with a reduced-intensity conditioning to minimize treatment-related organ toxicities but allow GvM effect. Our review aims to better define the role of allo-SCT in myeloma treatment particularly in the context of new immunomodulatory approaches.

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“…Also, the number of patients included is in most studies are relatively small. Still, overall, the 3-year OS from the time of salvage treatment is around 50%, and the 5-year OS between 30% and 40% in most later studies [ 46 , 61 , 62 , 63 , 64 , 65 ]. Maintenance treatment may improve the results [ 61 ].…”

Section: Allogeneic Transplantation As Relapse/progression Treatmementioning

confidence: 99%

“…Sobh et al found no significant difference in PFS or OS in relapsed/progressive patients who received a transplant from a 10/10 antigen-matched unrelated donor (MUD) as compared to a 9/10 mismatched one (MMUD); the 5-year PFS and OS were 27% and 39% compared to 14% and 33%, respectively [ 62 ]. However, cord blood transplants were inferior, with PFS and OS of 4% and 25% at this time.…”

Section: Allogeneic Transplantation As Relapse/progression Treatmementioning

confidence: 99%

“…Sibling donors are usually considered to be better than unrelated donors, but with optimal HLA typing and 10/10 antigen compatibility between donor and recipient, there seems to be no significant difference in outcome. In a recent study of patients treated with Allo as salvage after one or two Autos, a 9/10 antigen mismatch transplants seem to be at least as good as a 10/10 ones [ 62 ]. Twin donors are the best donors [ 95 , 96 ].…”

Section: Chromosomal Aberrations and Other Prognostic Factorsmentioning

confidence: 99%

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Allogeneic Transplantation in Multiple Myeloma—Does It Still Have a Place?

Gahrton

Iacobelli

Garderet

et al. 2020

JCM

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Novel drugs have improved survival for patients with multiple myeloma in recent years. However, the disease is still fatal. Allogeneic stem cell transplantation (Allo) has proven to cure some patients with the disease, but its role is controversial due to relatively high transplant-related toxicity and mortality (nonrelapse mortality, NRM). Using nonmyeloablative reduced-intensity conditioning (RIC), both toxicity and NRM can be reduced, and RICAllo is, therefore, an option for subgroups of patients. Upfront tandem autologous/RICAllo (Auto/RICAllo) was shown to be superior to single Auto or tandem Auto/Auto in both progression-free (PFS) and overall survival (OS) in two prospective studies with long-term follow-up, while three similarly designed studies did not detect a difference. A recent update of pooled patient data from four of these studies showed significantly superior PFS and OS with Auto/RICAllo. Importantly, none of these studies showed inferior results with Auto/RICAllo in patients less than 70 years of age. Auto/RICAllo appears to overcome some poor risk cytogenetic markers. Encouraging results have also been seen in treatment of relapsed patients. Combining Allo with new proteasome inhibitors and immunomodulatory drugs may further improve results. Other encouraging new cell therapies such as with CAR T-cells, NK- and CAR NK-cells may well have a place in combination with RICAllo. Such studies are warranted.

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Salvage use of allogeneic hematopoietic stem cell transplantation after reduced intensity conditioning from unrelated donors in multiple myeloma. A study by the Plasma Cell Disorders subcommittee of the European Group for Blood and Marrow Transplant Chronic Malignancies Working Party

Cited by 11 publications

References 11 publications

Safety and efficacy of haploidentical stem cell transplantation for multiple myeloma

Safety and efficacy of haploidentical stem cell transplantation for multiple myeloma

Allogeneic Stem Cell Transplantation in Multiple Myeloma

Allogeneic Transplantation in Multiple Myeloma—Does It Still Have a Place?

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