Propensity-score matched analysis of the efficacy of maintenance/continuous therapy in newly diagnosed patients with multiple myeloma: a multicenter retrospective collaborative study of the Japanese Society of Myeloma

Ozaki, Shuji; Handa, Hiroshi; Koiso, Hiromi; Saitoh, Takayuki; Sunami, Kazutaka; Ishida, Tadao; Suzuki, Kenshi; Narita, Takuma; Iida, Shinsuke; Nakamura, Yūichi; Suzuki, Kazuhito; Nishimura, Noriko; Murakami, Hirokazu; Shimizu, Kazuyuki

doi:10.1007/s00432-021-03668-6

Cited by 4 publications

(1 citation statement)

References 47 publications

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“…Continuous therapy has become a key strategy in patients with MM as it has been shown to prolong the duration of remission and significantly improve OS and PFS [205][206][207]. Continuous therapy represents the standard approach for patients with MM both at diagnosis and at relapse as it provides better disease control [202].…”

Section: Continuous Therapy After Autologous Hsct In MM Patientsmentioning

confidence: 99%

Recent Updates on Multiple Myeloma

2023

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extra-hematological toxicity, and the brief period of neutropenia [24, 25]. Outpatient HSCT has certain inclusion criteria and exclusion criteria as well as several advantages that include: significant reduction in costs; saving hospital beds; lower rate of infections; and lower morbidity and treatment-related mortality [24,[26][27][28].In patients with MM, maintenance therapy after autologous HSCT has been shown to deepen and prolong responses and increase OS and progression-free survival (PFS) [29]. Lenalidomide maintenance given after autologous HSCT till disease progression is the standard of care in patients with SR MM while bortezomib maintenance therapy after autologous HSCT is preferable in MM patients having: HR cytogenetics, renal insufficiency, inability to tolerate lenalidomide, and previous history of another cancer [30][31][32]. Continuous therapy has been shown to significantly improve OS and PFS [33, 34]. Continuous therapy till disease progression has become a key strategy in the treatment of patients with MM as it has been shown to improve duration of remission and it represents the standard approach for patients with MM both at diagnosis and at relapse [35, 36].Unfortunately, nearly all MM patients ultimately relapse, even those who experience a complete response (CR) to initial therapy [19]. Management of the relapsed disease remains a critical aspect of MM care and an important area of ongoing research [19]. New treatment strategies and therapeutic modalities are needed to treat MM in relapse, particularly in case of triple-refractory disease [1]. Treatment of relapsed MM should depend on: the number of relapses encountered; the previous anti-myeloma treatment; the presence of de novo or acquired drug resistance; aggressiveness of disease relapse particularly in case of extramedullary disease, plasma cell leukemia, or clonal evolution [3, 37].Minimal residual disease (MRD) is an important factor that can independently predict the prognosis of MM during treatment as undetectable MRD has been shown to improve PFS and OS regardless: disease status, prior transplant, or cytogenetic risk [38]. Flow cytometry has become a valuable tool to monitor MRD and evaluate the depth of CR. However, next-generation flow cytometry is more sensitive than the standard flow cytometry in detecting MRD in patients with MM [39]. Finally, the development of novel targeting therapies with different mechanisms of action is needed to achieve deep and durable responses in an attempt to cure MM while identification of tumor intrinsic and extrinsic resistance mechanisms may direct the design of combinations of novel drugs that prevent or overcome drug resistance so as to improve patient survival [40, 41].

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Section: Continuous Therapy After Autologous Hsct In MM Patientsmentioning

confidence: 99%

Recent Updates on Multiple Myeloma

2023

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Contribution of post-transplantation therapy to sustained MRD negativity in multiple myeloma: a retrospective analysis

Suzuki,

Gunji,

Kawashima

et al. 2023

Int J Hematol

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The outcome of autologous hematopoietic stem cell transplantation in patients with multiple myeloma. The experience of King Fahad Specialist Hospital in Dammam, Saudi Arabia

Ahmed¹,

Mutahar²,

Abduljalil³

et al. 2022

J Stem Cell Ther Transplant

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Background: Aautologous hematopoietic stem cell transplants (HSCT) is the standard of care for newly diagnosed patients with multiple myeloma (MM) who are eligible for autologous transplantation. Although cryopreservation is routinely employed, autologous HSCT can be performed using non-cryopreserved stem cells. Methods and materials: A retrospective study of patients with MM who received autologous HSCT between the 10th of October 2010 and the 31st of January 2022 at King Fahad Specialist Hospital (KFSH) in Dammam, Saudi Arabia was performed. Results: Over 11 years and 113 days, a total of 135 autologous HSCTs were performed for 119 patients with MM at our institution. Single autologous HSCTs were performed for 119 patients, while 16 of these patients received either planned tandem autologous transplants or second autografts due to either progression or relapse of their myeloma. The median age of patients with MM at autologous HSCT was 51.5 years. At presentation of their MM, the following high-risk (HR) features were encountered: stage III disease according to the revised international scoring system (RISS) in 12.3%; adverse cytogenetics in 31.93% of patients; advanced bone disease in 60.50%; and renal dysfunction or failure in 11.76% of patients. A total of 104 autologous HSCTs (77.04%) were performed without cryopreservation while 31 autografts (22.96%) were performed using cryopreserved apheresis stem cell products. Additionally, 54 autologous HSCTs (40.00%) were done at outpatient while 81 autografts (60.00%) were performed in an inpatient setting. Survival for 100 days post-HSCT for all patients with MM who received autologous transplants including those done at outpatient was 100%. The 4 years overall survival (OS) an progression-free survival (PFS) for patients with MM who received non- cryopreserved or fresh autologous HSCTs were 82% and 68% respectively. Conclusion: Autologous HSCT without cryopreservation is safe, and feasible and can lead to short-term as well as long-term outcomes that are comparable to autologous transplantation with cryopreservation. Non- cryopreserved autologous grafts allow the performance of autologous transplants in an outpatient setting to save beds and reduce costs.

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Propensity-score matched analysis of the efficacy of maintenance/continuous therapy in newly diagnosed patients with multiple myeloma: a multicenter retrospective collaborative study of the Japanese Society of Myeloma

Cited by 4 publications

References 47 publications

Recent Updates on Multiple Myeloma

Recent Updates on Multiple Myeloma

Contribution of post-transplantation therapy to sustained MRD negativity in multiple myeloma: a retrospective analysis

The outcome of autologous hematopoietic stem cell transplantation in patients with multiple myeloma. The experience of King Fahad Specialist Hospital in Dammam, Saudi Arabia

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