Incidence of Second Primary Malignancies after Autologous Transplantation for Multiple Myeloma in the Era of Novel Agents

Sahebi, Firoozeh; Iacobelli, Simona; Sbianchi, Giulia; Köster, Linda; Blaise, Didier; Reményi, Péter; Russell, Nigel H.; Ljungman, Per; Kobbe, Guido; Apperley, Jane F.; Trněný, Marek; Krejčí, Marta; Wiktor-Jedrzejczak, W; Sanchez, James F.; Schaap, Nicolaas; Isaksson, Cecilia; Lenhoff, Stig; Browne, Paul; Scheid, Christof; Wilson, Keith; Yakoub-Agha, Ibrahim; Muñiz, Soledad González; Schönland, Stefan; Morris, Curly; Garderet, Laurent

doi:10.1016/j.bbmt.2018.01.006

Cited by 11 publications

(5 citation statements)

References 25 publications

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“…Increased SPMs in myeloma patients have been associated with older age [26,27]. Our data confirms mm-MDS patients to be younger than de novo MDS patients but older than tMDS patients.…”

Section: Discussionsupporting

confidence: 73%

Therapy-related myeloid neoplasms following treatment for multiple myeloma—a single center analysis

et al. 2022

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Myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) can be late complications following mutagenic treatment. Limited data is available on the outcome of patients developing therapy-related MDS and AML after treatment for multiple myeloma (MM). We identified 250 patients with therapy-associated MDS or AML in the Duesseldorf MDS registry. Of those, 50 patients were previously diagnosed with multiple myeloma (mm-MDS/AML). We compared them to patients with de novo MDS (n = 4862) and to patients with MDS following other underlying diseases (tMDS) (n = 200). mm-MDS patients and tMDS patients showed similar karyotypes and degrees of cytopenia. However, mm-MDS patients had significantly higher blast counts and more often belonged to the high-risk group according to the International Prognostic Scoring System (IPSS) (both p < 0.05). Although the rate of progression to AML was similar in mm-MDS and tMDS, both transformed significantly more often than de novo MDS (p < 0.05). Median overall survival of patients with mm-MDS (13 months; range: 1–99) and tMDS (13 months; range 0–160) was also similar yet significantly shorter than patients with de novo MDS (32 months; range 0–345 months; p < 0.05). Furthermore, survival of mm-MDS patients was not affected by myeloma activity. Despite significantly more high-risk disease and higher blast cell counts, myeloma-associated MDS-patients show features akin to other tMDS. Survival is similar to other tMDS and irrespective of myeloma remission status or transformation to AML. Thus, patient outcome is not determined by competing clones but rather by MDS governing the stem cell niche.

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“…Increased SPMs in myeloma patients have been associated with older age [26,27]. Our data confirms mm-MDS patients to be younger than de novo MDS patients but older than tMDS patients.…”

Section: Discussionsupporting

confidence: 73%

Therapy-related myeloid neoplasms following treatment for multiple myeloma—a single center analysis

et al. 2022

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“…Although the cumulative incidence of t-MDS/t-AML was higher than the rate of 1.4% at 6 years reported in the prospective observational CALM (Collaboration to Collect Autologous Transplant outcome in Lymphoma and Myeloma) study by the EBMT [22], it was comparable to the general incidence of t-MDS/t-AML after auto-HCT of 4-5% after 5 years as reviewed in [23]. The incidence of non-myeloid SPMs was below the incidence reported by Sahebi et al [22]. These are important observations given the fact that high dose melphalan was given for the second or even the third time in this patient cohort.…”

Section: Osmentioning

confidence: 54%

Autologous hematopoietic cell transplantation for relapsed multiple myeloma performed with cells procured after previous transplantation–study on behalf of CMWP of the EBMT

Drozd‐Sokołowska

Gras

Zinger

et al. 2022

Bone Marrow Transplant

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Autologous hematopoietic cell transplantation (auto-HCT) may be performed in multiple myeloma (MM) patients relapsing after a previous auto-HCT. For those without an adequate dose of stored stem cells, remobilization is necessary. This retrospective study included patients who, following disease relapse after the first auto-HCT(s), underwent stem cell remobilization and auto-HCT performed using these cells. There were 305 patients, 68% male, median age at salvage auto-HCT was 59 years. The median time to relapse after the first-line penultimate auto-HCT(s) was 30.6 months, the median follow-up after salvage auto-HCT 31 months. The 2- and 4-year non-relapse mortality (NRM) after the salvage auto-HCT was 5 and 9%, the relapse incidence 56 and 76%, respectively. Overall survival (OS) after 2 and 4 years was 76 and 52%, progression-free survival (PFS) 39 and 15%. In multivariable analysis an increasing interval between the penultimate auto-HCT and relapse was associated with better OS and PFS, later calendar year of salvage auto-HCT with better OS. In conclusion, salvage auto-HCT performed with cells remobilized after a previous auto-HCT was associated with acceptable NRM. The leading cause of failure was disease progression of MM, which correlated with a shorter interval from the penultimate auto-HCT to the first relapse.

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“…Both alkylating agents and lenalidomide have been linked to the development of SPMs. A contemporary EBMT analysis in the era of novel agents found that the cumulative reported incidence of hematologic and solid malignancies 6 years posttransplant was 1.4% and 3.6%, respectively [60]. Although vigilance is required in monitoring for SPMs, current maintenance approaches have contributed to significantly improved survival and outweigh the relatively small increased risk of SPMs.…”

Section: Other Considerations With Asctmentioning

confidence: 99%

Are Autologous Stem Cell Transplants Still Required to Treat Myeloma in the Era of Novel Therapies? A Review from the Chronic Malignancies Working Party of the EBMT

Garderet

Morris

Beksaç

et al. 2020

Biology of Blood and Marrow Transplantation

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Melphalan at a myeloablative dose followed by autologous stem cell transplantation (ASCT) remains the standard of care for transplant-eligible patients with myeloma. However, therapies such as new immunomodulatory drugs and proteasome inhibitors and, more recently, monoclonal antibodies and chimeric antigen receptor T cells are challenging the traditional role of ASCT. Which patients benefit from ASCT? Can its use be delayed until first relapse? The field is moving rapidly as novel agents lead to new patient care strategies. The place of ASCT in this changing landscape will be reviewed and reassessed.

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Incidence of Second Primary Malignancies after Autologous Transplantation for Multiple Myeloma in the Era of Novel Agents

Cited by 11 publications

References 25 publications

Therapy-related myeloid neoplasms following treatment for multiple myeloma—a single center analysis

Therapy-related myeloid neoplasms following treatment for multiple myeloma—a single center analysis

Autologous hematopoietic cell transplantation for relapsed multiple myeloma performed with cells procured after previous transplantation–study on behalf of CMWP of the EBMT

Are Autologous Stem Cell Transplants Still Required to Treat Myeloma in the Era of Novel Therapies? A Review from the Chronic Malignancies Working Party of the EBMT

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