Allogeneic hematopoietic cell transplantation for multiple myeloma in Europe: trends and outcomes over 25 years. A study by the EBMT Chronic Malignancies Working Party

Abstract

We describe the use and outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for multiple myeloma (MM) in Europe between January 1990 and December 2012. We identified 7333 patients, median age at allo-HSCT was 51 years (range: 18-78), of whom 4539 (62%) were males. We distinguished three groups: (1) allo-HSCT upfront (n=1924), (2) tandem auto-allo-HSCT (n=2004) and (3) allo-HSCT as a second line treatment and beyond (n=3405). Overall, there is a steady increase in numbers of allo-HSCT over the years. Upfront allo-HSCT use increased up to year 2000, followed by a decrease thereafter and represented 12% of allo-HSCTs performed in 2012. Tandem auto-allo-HSCT peaked around year 2004 and contributed to 19% of allo-HSCTs in 2012. Allo-HSCT as salvage after one or two or three autografts was steadily increasing over the last years and represented 69% of allo-HSCTs in 2012. Remarkable heterogeneity in using allo-HSCT was observed among the different European countries. The 5-year survival probabilities from time of allo-HSCT for the three groups after year 2004 were 42%, 54% and 32%, respectively. These results show that the use of allo-HSCT is increasing in Europe, especially as second line treatment and beyond. There is an unmet need for well-designed prospective studies investigating allo-HSCT as salvage therapy for MM.

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

“…Simona Iacobelli, 3 Linda Koster, 4 Anja Van Biezen, 4 Nathalie Fegueux, 5 Reza Tabrizi, 6 Jürgen Finke, 7 Jean El-Cheikh, 8 Martin Schipperus, 9 Ellen Meijer, 10 Peter von dem Borne, 11 …”

“…[3][4][5][6][7][8] We recently showed that the number of patients who received an allo-HSCT for MM in Europe is steadily increasing, and about 70% of cases are performed at a later stage of the disease, mainly following failure after one or two autologous HSCTs (auto-HSCT). 9 Herein, we aim to present a refined analysis considering the current most common indication for allogeneic HSCT in MM, namely salvage haematologica 2017; 102:e271 allo-HSCT after one or two auto-HSCTs using reducedintensity conditioning (RIC) and an alternative donor. Therefore, we contrasted the outcomes of patients receiving cord blood (CB) allo-HSCT with those of comparable patients receiving peripheral blood stem cells (PBSCs) during the same period of time from either 10/10 human leukocyte antigen (HLA)-matched unrelated donors (MUD) or 9/10 HLA-mismatched unrelated donors (MMUD).…”

Is there still a role for stem cell transplantation in multiple myeloma?

“…A European analysis of the EBMT registry on the use of allo‐SCT among patients with MM showed a steady increase in the use of allo‐SCT, particularly later in the course of the disease, with a parallel increase in the use of RIC over myeloablative conditioning. Among 3405 patients with MM undergoing allo‐SCT after ASCT, the 5‐year PFS and OS rates were 15% and 32%, respectively, whereas the NRM rate was 29%; this confirmed high toxicity and relapse rates with limited benefit …”

Conditioning‐based outcomes after allogeneic transplantation for myeloma following a prior autologous transplant (1991‐2012) on behalf of EBMT CMWP

“…In the absence of an evidence‐based consensus, transplant centres have adopted a range of different approaches to alloHCT over recent decades . RIC or, less commonly, MAC alloHCT is sometimes performed shortly after diagnosis in selected high‐risk patients.…”