Single versus tandem autologous stem-cell transplantation in patients with newly diagnosed multiple myeloma and high-risk cytogenetics. A retrospective, open-label study of the PETHEMA/Spanish Myeloma Group (GEM)

Villalba, Ana; González-Rodríguez, Ana Pilar; Arzuaga‐Méndez, Javier; Puig, Noemí; Arnao, Mario; Arguiñano, José-María; Jiménez, María José; Canet, Marta; Teruel, Ana Isabel; Sola, M. A.; Díaz, Francisco Javier Llorca; Encinas, Cristina; García, A. Miguel; Rosiñol, Laura; Suarez, Arturo; González, Marta Sonia; Izquierdo, Isabel; Hernández, Miguel T.; Infante, María Stefania; Sánchez, María José; Sampol, Antònia; Rubia, Javier de la

doi:10.1080/10428194.2022.2123229

Cited by 5 publications

(6 citation statements)

References 35 publications

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“…This could eventually lead to a reduction of ASCT and reduce target collection goals accordingly. [31][32][33][34][35] Our analysis has certain limitations; it was performed retrospectively and included a limited number of patients. Further prospective randomized trials should address this issue more precisely.…”

Section: Discussionmentioning

confidence: 99%

“…Another issue to be considered in the currently evolving concepts of MM therapy is that of target collection yields. It is common practice to collect at least 4 × 10 6 CD34+ cells/kg body weight, thus enabling treatment with tandem high‐dose therapy, which is currently state of the art for patients with high‐risk MM 31 …”

Section: Discussionmentioning

confidence: 99%

“…It is common practice to collect at least 4 Â 10 6 CD34+ cells/kg body weight, thus enabling treatment with tandem high-dose therapy, which is currently state of the art for patients with high-risk MM. 31 New cellular treatment options in MM, including chimeric antigen receptor (CAR)-T-cell therapy 32,33 and bispecific antibodies, 34,35 are leading to profound changes in the treatment landscape of relapsed/refractory myeloma. Currently, enrolling clinical trials have begun to study CAR-T-cells and bispecific antibodies in the context of frontline treatment.…”

Section: Discussionmentioning

confidence: 99%

“…It will be of particular interest if these new therapeutic options lead to a practice change in transplant‐eligible patients, especially regarding the necessity of a (tandem) ASCT. This could eventually lead to a reduction of ASCT and reduce target collection goals accordingly 31–35 …”

Section: Discussionmentioning

confidence: 99%

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Steady‐state versus chemotherapy‐based hematopoietic cell mobilization after anti‐CD38‐based induction therapy in newly diagnosed multiple myeloma

Teipel,

Rieprecht,

Trautmann‐Grill

et al. 2023

Transfusion

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BackgroundThe incorporation of anti‐CD38 monoclonal antibodies (mAb) in induction regimens of newly diagnosed transplant‐eligible multiple myeloma (MM) patients has been established as a new standard. However, the optimal strategy of stem cell mobilization in this context is not yet clear.Study Design and MethodsFrom May 2020 till September 2022, we retrospectively reviewed patients receiving anti‐CD38 mAb‐based induction therapy followed by stem cell mobilization either in a steady‐state protocol (SSM) using 10 μg/kg granulocyte colony‐stimulating factor (G‐CSF) for 5 days or in a chemotherapy‐based protocol (CM) using 1–4 g/m2 cyclophosphamide and G‐CSF.ResultsOverall, 85 patients (median age 61 years) were included in the analysis. In total, 90 mobilization attempts were performed, 42 with SSM and 48 with CM. There was no significant difference in the median concentration of CD34+ cells in peripheral blood (PB) prior to apheresis between SSM and CM (61/μL vs. 55.4/μL; p = .60). Cumulative CD34+ yields did not differ between the groups with median of 6.68 and 6.75 × 106/kg body weight, respectively (p = .35). The target yield (≥4 × 106 CD34+ cells/kg body weight) was reached in 88% (CM) and 86% (SSM), with a high proportion even after a single apheresis session (76% vs. 75%).Plerixafor was found to be more frequently used in SSM (52%) than in CM (23%; p < .01). A total of 83 patients underwent autologous transplantation and all were engrafted.ConclusionsStem cell collection in patients undergoing anti‐CD38‐based induction therapy is feasible with either CM or SSM, although SSM more frequently requires plerixafor.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Steady‐state versus chemotherapy‐based hematopoietic cell mobilization after anti‐CD38‐based induction therapy in newly diagnosed multiple myeloma

Teipel,

Rieprecht,

Trautmann‐Grill

et al. 2023

Transfusion

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“…Although long-term PFS and OS of STaMINA trial confirmed no difference in PFS and OS between the three arms, HR patients who underwent double ASCT had a 5-year PFS of 43.7% vs. 37.3% in those receiving ASCT/VRD consolidation vs. 32% in those undergoing ASCT/maintenance ( p = 0.03) [ 95 ], with no OS difference. A recent retrospective, multi-center study by PETHEMA/Spanish Myeloma Group (GEM) [ 112 ] compared outcome of HR patients who underwent single or double ASCT in a real-world setting. No difference in terms of PFS and OS was observed but patients with del(17p) receiving single ASCT had median PFS of 41 months while 52% of patients receiving double ASCT were alive and disease free at 48 months.…”

Section: High Risk Multiple Myeloma and Risk-adapted Therapiesmentioning

confidence: 99%

Current Main Topics in Multiple Myeloma

Morè¹,

Corvatta²,

Manieri³

et al. 2023

Cancers

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Multiple Myeloma (MM) remains a difficult to treat disease mainly due to its biological heterogeneity, of which we are more and more knowledgeable thanks to the development of increasingly sensitive molecular methods that allow us to build better prognostication models. The biological diversity translates into a wide range of clinical outcomes from long-lasting remission in some patients to very early relapse in others. In NDMM transplant eligible (TE) patients, the incorporation of mAb as daratumumab in the induction regimens, followed by autologous stem cell transplantation (ASCT) and consolidation/maintenance therapy, has led to a significant improvement of PFS and OS.; however, this outcome remains poor in ultra-high risk MM or in those who did not achieve a minimal residual disease (MRD) negativity. Several trials are exploring cytogenetic risk-adapted and MRD-driven therapies in these patients. Similarly, quadruplets-containing daratumumab, particularly when administered as continuous therapies, have improved outcome of patients not eligible for autologous transplant (NTE). Patients who become refractory to conventional therapies have noticeably poor outcomes, making their treatment a difficult challenge in need of novel strategies. In this review, we will focus on the main points regarding risk stratification, treatment and monitoring of MM, highlighting the most recent evidence that could modify the management of this still incurable disease.

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A predictive risk‐scoring model for survival prognosis of multiple myeloma based on gain/amplification of 1q21: Experience in a tertiary hospital in South‐Western China

Xiong,

Liang,

Tang

et al. 2024

Cancer Medicine

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BackgroundChromosomal 1q gains and amplifications (+1q21) are frequently observed in patients with newly diagnosed multiple myeloma (NDMM). However, the interpretation of the high‐risk (HR) prognostic implications stemming from 1q21 abnormalities remain challenging to implement effectively.MethodsIn a comprehensive analysis of 367 consecutive patients with symptomatic MM, we assessed the prognostic significance of +1q21 using FISH with a threshold of 7.4%. The patient cohort was randomly divided into a training set (66.5%, n = 244) and a validation set (33.5%, n = 133). A multivariate Cox regression analysis was conducted to identify significant prognostic factors associated with PFS. Weight scores were assigned to each risk factor based on the β‐value of the corresponding regression coefficient. A predictive risk‐scoring model involving +1q21 was then developed, utilizing the total score derived from these weight scores. The model's discriminative ability was evaluated using the AUC in both the training and validation sets. Finally, we compared the performance of the +1q21‐involved risk with the established R‐ISS and R2‐ISS models.ResultsUpon initial diagnosis, 159 patients (43.32%) exhibited +1q21, with 94 (59.11%) having three copies, referred to as Gain(1q21), and 65 (40.89%) possessing four or more copies, referred to as Amp (1q21). Both were significantly linked to a reduced PFS in myeloma (p < 0.05), which could be effectively mitigated by ASCT. The +1q21‐involved risk model, with an AUC of 0.697 in the training set and 0.725 in the validation set, was constructed including Gain(1q21), Amp(1q21), no‐ASCT, and TP53 deletion. This model, termed the ultra‐high‐risk (UHR) model, demonstrated superior performance in predicting shorter PFS compared to the R‐ISS stage 3 and R2‐ISS stage 4.ConclusionThe UHR model, which integrates the presence of +1q21 with no‐ASCT and TP53 deletion, is designed to identify the early relapse subgroup among patients with +1q21 in NDMM.

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Single versus tandem autologous stem-cell transplantation in patients with newly diagnosed multiple myeloma and high-risk cytogenetics. A retrospective, open-label study of the PETHEMA/Spanish Myeloma Group (GEM)

Cited by 5 publications

References 35 publications

Steady‐state versus chemotherapy‐based hematopoietic cell mobilization after anti‐CD38‐based induction therapy in newly diagnosed multiple myeloma

Steady‐state versus chemotherapy‐based hematopoietic cell mobilization after anti‐CD38‐based induction therapy in newly diagnosed multiple myeloma

Current Main Topics in Multiple Myeloma

A predictive risk‐scoring model for survival prognosis of multiple myeloma based on gain/amplification of 1q21: Experience in a tertiary hospital in South‐Western China

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