Hematopoietic Stem Cell Transplantation in Multiple Myeloma: A Retrospective Study of the Société Française de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC)

Abstract

Because the indication of allograft (allogeneic stem cell transplantation [alloSCT]) for multiple myeloma (MM) has widened in recent years, thanks to the development of reduced-intensity conditionings (RIC), it is still unclear if myeloablative conditioning (MAC) remains appropriate. This study compares retrospectively outcomes of patients undergoing either RIC or MAC regimens for MM. Based on the SFGM-TC registry, we included 446 MM patients receiving alloSCT between 1999 and 2009 for whom a minimal data set was available. Median follow-up for the entire cohort was 33.6 months (range, 0 to 164.5). RIC and MAC populations were different regarding age (53.5 versus 47.1 years, respectively), number of prior autologous (auto)SCTs (93.2% versus 79.6% had at least 2 autoSCTs), and stem cell source (90.2% versus 61.2% received peripheral blood). For RIC and MAC populations the nonrelapse mortality at 2 years was 24.6% and 22.4%, respectively, progression-free survival 35.5% and 51.1%, and overall survival 59.5% and 66.7% (not significant). These outcomes were not affected by conditioning intensity either on univariate or multivariate analysis. Despite some limitations in the study design, these results indicate that MAC should remain a valuable option in alloSCT for MM, especially for young and less-treated patient with no comorbidity. The constant progress in induction treatments of MM and supportive care after alloSCT could improve these results in the near future.

Reducing Treatment-Related Mortality Did Not Improve Outcomes of Allogeneic Myeloablative Hematopoietic Cell Transplantation for High-Risk Multiple Myeloma: A University of Michigan Prospective Series

“…43 Allogeneic hematopoietic cell transplantation, which utilizes an alloimmune reaction against MM (GVM effect), has emerged as an alternative treatment option, with possible prolonged MM control and curative potential, in these patients. [12][13][14][15][16][17][18][19][20][21] The existence of GVM effect was demonstrated directly in patients who received DLI for MM relapse after Allo-HCT. [16][17][18] DLI was shown to induce complete and partial response in 40-55% of these patients, with accompanying acute and chronic GVHD rates of 55-57% and 26-47%, respectively.…”

“…[7][8][9][10][11] Allogeneic hematopoietic cell transplantation (Allo-HCT) has been explored in advanced MM as a curative option through a graft-versus-myeloma (GVM) effect. [12][13][14][15][16][17][18][19][20][21] The existence of a GVM effect was demonstrated following the observation of complete responses after donor lymphocyte infusion (DLI) and withdrawal of immunosuppression in patients with MM relapsing after Allo-HCT. [16][17][18] Unfortunately, conventional myeloablative conditioning is associated with an unacceptably high early treatment-related mortality (TRM) of up to 50%.…”

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

“…The French Society of Bone Marrow and Cellular Therapy (SFGM‐TC) compared the outcomes of 446 patients with myeloma who received either RIC (n = 397) or MAC (n = 49) regimens in 31 centres between 1999 and 2009 and found no significant difference in OS (59.5% vs 66.7%) at 2 years . In their study, 93.2% of the RIC and 79.6% of the MAC cohorts had at least one prior autoHCT.…”

“…AlloMAC was as- Figure 3C,D, respectively. Auto-Allo groups at 5 years were 39% (95% CI 31%-48%), 44.7% (95% CI 32%-57%), 19.1% (95% CI 6%-32%) and 34.2% (17%-51%), respectively. The principal finding was that OS was markedly lower in the MAC group (P = .004) largely due to the fact that NRM was significantly higher in the MAC group, being 33.3% (95% CI 22-45)…”

Italian consensus conference for the outpatient autologous stem cell transplantation management in multiple myeloma

“…3,4 High-dose melphalan (HDM) at 200 mg/m 2 is the standard conditioning for ASCT 5,6 and, today, the treatment should be considered a safe procedure with a very low transplant-related mortality (TRM). [7][8][9] The significant increase in the waiting lists generated concerns about the appropriate use of health care resources and, over the past years, some studies have investigated the safety, efficacy and potential cost advantages of reducing hospital stay for patients undergoing ASCT. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] The ease of administering HDM, the relatively low extra-hematological toxicity and the short period of neutropenia 5,6 make MM patients ideal candidates for outpatient ASCT programs.…”