First line<i>vs</i>delayed transplantation in myeloma: Certainties and controversies

Brioli, Annamaria

doi:10.5500/wjt.v6.i2.321

Cited by 8 publications

(9 citation statements)

References 71 publications

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“…Multiple myeloma remains an incurable disease for most patients . For younger MM patients, the standard of care for first‐line treatment involves induction therapy consolidated with HDCT and autologous peripheral blood stem cell (ASCT) rescue followed by maintenance treatment . Almost all patients with MM will relapse following initial therapy, the majority within 3 years after an ASCT .…”

Section: Discussionmentioning

confidence: 99%

“…2,3,33 For younger MM patients, the standard of care for first-line treatment involves induction therapy consolidated with HDCT and autologous peripheral blood stem cell (ASCT) rescue followed by maintenance treatment. [1][2][3][4]7 Almost all patients with MM will relapse following initial therapy, the majority within 3 years after an ASCT. 5,6,16 The role of a second ASCT (ASCT2) for relapse treatment is less established.…”

Section: Discussionmentioning

confidence: 99%

“…Autologous stem cell transplantation (ASCT) after high-dose melphalan chemotherapy (HDCT) is part of the first-line standard treatment algorithm for patients with symptomatic multiple myeloma (MM) up to the age of 70 years. [1][2][3][4][5][6][7][8][9] With the incorporation of novel agents into this strategy, progression-free survival (PFS) and overall survival (OS) rates of such patients have markedly improved within the last decade. [10][11][12][13][14][15] However, almost all patients with MM will ultimately relapse at some stage following initial therapy, the majority within 3 years after ASCT, and no plateau is observed in their OS.…”

Section: Introductionmentioning

confidence: 99%

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Prolonged survival after second autologous transplantation and lenalidomide maintenance for salvage treatment of myeloma patients at first relapse after prior autograft

Gössi

Jeker

Taleghani

et al. 2018

Hematological Oncology

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Autologous stem cell transplantation (ASCT) as part of the primary therapy in multiple myeloma (MM) is standard practice. In contrast, the role of a second ASCT (ASCT2) and subsequent lenalidomide maintenance for relapsed disease remains unclear. In this study, we analysed 86 consecutive MM patients with a first relapse after prior ASCT receiving either a second ASCT or conventional chemotherapy. After a median follow-up of 37.7 months since first relapse, 54 (62.8%) patients were still alive and 29 (33.7%) without progression. Sixty-one (71.0%) patients received ASCT2 and had better progression-free survival (PFS) (30.2 versus 13.0 mo; P = .0262) and overall survival (OS) rates (129.6 versus 33.5 mo; P = .0003) compared with 25 (29.0%) patients with conventional treatment. Patients relapsing later than 12 months after ASCT1 benefitted from a second ASCT with better PFS2 (P = .0179) and OS2 (P = .0009). Finally, lenalidomide maintenance after ASCT2 was associated with longer PFS (41.0 vs 21.6 mo; P = .0034) and better OS (not yet reached vs 129.6 mo; P = .0434) compared with patients without maintenance. Our data suggest that a second ASCT and lenalidomide maintenance given at first relapse in MM after prior ASCT are associated with better survival rates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prolonged survival after second autologous transplantation and lenalidomide maintenance for salvage treatment of myeloma patients at first relapse after prior autograft

Gössi

Jeker

Taleghani

et al. 2018

Hematological Oncology

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“…ASCT remains an important component of MM therapy for eligible patients even in the era of novel agents [12]. Multiple studies have demonstrated that stem cell mobilization followed by harvest and storage of PBSCs for a delayed ASCT is safe and feasible [13]. However, one concern that remains about a delayed ASCT approach is that not all patients who experience disease relapse will eventually undergo an ASCT [14].…”

Section: Discussionmentioning

confidence: 99%

Analysis of Clinical Factors and Outcomes Associated with Nonuse of Collected Peripheral Blood Stem Cells for Autologous Stem Cell Transplants in Transplant-Eligible Patients with Multiple Myeloma

Kansagra

Gonsalves

Gertz

et al. 2018

Biology of Blood and Marrow Transplantation

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Collection and storage of peripheral blood stem cells (PBSCs) for use in autologous stem cell transplantation (ASCT) upon first disease relapse is an accepted practice for eligible patients with multiple myeloma (MM). However, little is known about the factors and outcomes associated with nonuse of these collected and stored PBSCs by MM patients who intended to have a delayed ASCT. From January 1, 2004 to December 31, 2014 we identified 342 patients who underwent collection and storage of their PBSCs in anticipation of a delayed ASCT upon first disease relapse. Among these, 176 patients (11%) had not proceeded to a delayed ASCT at the time of this study analysis. The most common reason for not undergoing an ASCT was not experiencing a relapse on first-line therapy (53%, n = 94). However, 11% of patients (n = 37) who planned for a delayed ASCT were unable to undergo an ASCT at disease relapse. Comparison with a control group of MM patients who underwent an upfront ASCT suggested a worse overall survival from diagnosis in these patients who were ASCT ineligible at disease relapse (112 versus 80 months, P = .011). This study provides valuable data for patients and care providers to take into consideration when deciding on whether to pursue an upfront or a delayed ASCT.

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“…The choice of drugs used in salvage regimens has expanded recently, so therapeutic decisions at relapse can be difficult. Improving understanding of factors affecting outcomes at relapse and responses to second‐line therapy will facilitate joint treatment decisions between clinicians and patients (Brioli, ) and identify patient subgroups that fare poorly with current treatment options and require new approaches.…”

Section: Patient Characteristics At Relapse (Relapse <12 Months and >mentioning

confidence: 99%

A new prognostic model for myeloma patients relapsing from upfront autologous transplantation based on ISS and PFS1

et al. 2018

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First linevsdelayed transplantation in myeloma: Certainties and controversies

Cited by 8 publications

References 71 publications

Prolonged survival after second autologous transplantation and lenalidomide maintenance for salvage treatment of myeloma patients at first relapse after prior autograft

Prolonged survival after second autologous transplantation and lenalidomide maintenance for salvage treatment of myeloma patients at first relapse after prior autograft

Analysis of Clinical Factors and Outcomes Associated with Nonuse of Collected Peripheral Blood Stem Cells for Autologous Stem Cell Transplants in Transplant-Eligible Patients with Multiple Myeloma

A new prognostic model for myeloma patients relapsing from upfront autologous transplantation based on ISS and PFS1

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