Toxicity of a second autologous peripheral blood stem cell transplant in patients with relapsed or recurrent multiple myeloma

Burzynski, J.A.; Toro, Juan J.; Patel, Roshni; Lee, Shuko; Greene, Richard M.; Ochoa-Bayona, José L.; Frei, Christopher R.; Freytes, César O.

doi:10.1080/10428190903085936

Cited by 41 publications

(59 citation statements)

References 22 publications

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“…122 Similar to previously published smaller studies, [123][124][125] this retrospective analysis demonstrated that a second autologous SCT is associated with superior relapse-associated mortality compared with conventional chemotherapy (68% vs 78%), along with improved OS (32% vs 22%) at 4 years. In this analysis, factors associated with improved OS and PFS included younger age (<55 years), beta-2 microglobulin level <2.5 mg/L at diagnosis, a remission duration of >9 months, and better than a PR to their first autologous SCT.…”

Section: Tandem Sctssupporting

confidence: 73%

Multiple Myeloma, Version 3.2017, NCCN Clinical Practice Guidelines in Oncology

Kumar¹,

Callander²,

Alsina³

et al. 2017

J Natl Compr Canc Netw

174

129

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Section: Tandem Sctssupporting

confidence: 73%

Multiple Myeloma, Version 3.2017, NCCN Clinical Practice Guidelines in Oncology

Kumar¹,

Callander²,

Alsina³

et al. 2017

J Natl Compr Canc Netw

174

129

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“…19 Auto-SCT2 has been employed in the management of recurrent MM by several groups. [9][10][11][12][13][14][15][16][17] In the era of novel agents, our study tries to define the role of an auto-SCT2 as salvage therapy in patients who have had a previous auto-SCT (auto-SCT1). In our single center experience, auto-SCT2 appears to be a safe and effective treatment strategy for relapsed MM.…”

Section: Discussionmentioning

confidence: 99%

“…There has been a growing interest in the role for auto-SCT2 in the salvage setting and several studies have shown it to be safe and efficacious in selected patients. [9][10][11][12][13][14][15][16][17] Many of these studies have included small numbers of patients, which limits the ability to identify factors associated with good outcomes in this group of patients. We reviewed our experience of such auto-SCT2 in relapsed or refractory myeloma patients to characterize the efficacy of auto-SCT2, the associated toxicity, and to identify clinical and laboratory characteristics that can help select patients likely to benefit from this approach.…”

Section: Introductionmentioning

confidence: 99%

Second auto-SCT for treatment of relapsed multiple myeloma

Gonsalves

Gertz

Lacy

et al. 2012

Bone Marrow Transplant

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High-dose therapy and auto-SCT remain integral in the initial treatment of multiple myeloma (MM), and are increasingly being applied for management of relapsed disease. We examined the outcomes in 98 patients undergoing salvage auto-SCT (auto-SCT2) for relapsed MM after receiving an initial transplant (auto-SCT1) between 1994 and 2009. The median age at auto-SCT2 was 60 years (range: 35-74). The median time between auto-SCT1 and auto-SCT2 was 46 months (range: 10-130). Treatment-related mortality was seen in 4%. The median PFS from auto-SCT2 was 10.3 (95% confidence interval (CI): 7-14) months and the median OS from auto-SCT2 was 33 months (95% CI: 28-51). In a multivariable analysis, shorter time to progression (TTP) after auto-SCT1, not achieving a CR after auto-SCT2, higher number of treatment regimens before auto-SCT2 and a higher plasma cell labeling index at auto-SCT2 predicted for shorter PFS. However, only a shorter TTP after auto-SCT1 predicted for a shorter OS post auto-SCT2. Hence, auto-SCT2 is an effective and feasible therapeutic option for MM patients relapsing after other treatments, especially in patients who had a TTP of at least 12 months after their auto-SCT1.

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“…Over time, several reports have demonstrated the feasibility of this salvage strategy. [66][67][68][69][70][71][72][73] Most data are derived from retrospective studies and are based on experiences with relatively small numbers of selected patients. In this setting, PFS has been shown to range from 7 to 22 months, and the treatment-related mortality was acceptable, ranging from 0 to 8%.…”

Section: What Is the Role Of Autologous Stem Cell Transplantation As mentioning

confidence: 99%

Treatment of autologous stem cell transplant-eligible multiple myeloma patients: ten questions and answers

Mohty

Harousseau

2014

Haematologica

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F e r r a t a S t o r t i F o u n d a t i o nics and renal impairment. In the era of novel agents, the role of transplant itself is being questioned and trials are ongoing to establish whether transplant can be delayed until after relapse in some patients. The current ongoing studies are aimed towards improving the different steps of the procedure with the aim of further improving efficacy and tolerability. This review addresses a number of questions surrounding the different steps of the transplant procedure and summarizes the available research evidence as a basis for decision making. Is high-dose therapy plus autologous stem cell transplantation superior to conventional chemotherapy?The concept of high-dose therapy (HDT) plus autologous stem cell transplantation (ASCT) was developed in the 1980s. The objective of ASCT was to support highdose therapy (HDT) in order to reduce the duration and toxicity of severe myelosuppression. The Intergroupe Francophone du Myelome (IFM) was the first to conduct a randomized trial showing the superiority of HDT/ASCT over conventional chemotherapy in patients under 65 years of age regarding response rate, event-free survival (EFS) and overall survival (OS).1 These findings were confirmed seven years later in a larger study conducted by the UK Medical Research Council (MRC Myeloma VII trial). 2Following these results, HDT/ASCT became the standard of care in patients without severe comorbidities and under 65 years of age.Overall, 7 randomized studies have compared ASCT/HDT to conventional chemotherapy. 3 While EFS was superior with HDT/ASCT in 5 of 7 trials, OS was significantly prolonged in only 3 trials. These results were confirmed by a meta-analysis that showed a significant benefit for HDT/ASCT in terms of EFS but no benefit in terms of OS. 4 This was partly explained by the impact of ASCT at relapse in patients initially treated with conventional chemotherapy. Therefore, although the majority of myeloma experts recommend HDT/ASCT as part of initial therapy, some experts consider that delaying ASCT until relapse remains a valuable approach.Importantly, the use of HDT/ASCT was the major cause of OS improvement observed in younger patients before the introduction of novel agents, such as immunomodulatory drugs (IMIDs) and proteasome inhibitors. 5 However, despite the demonstrated efficacy of the procedure, relapses ultimately occurred in the vast majority of patients and long remissions (and possible cures) remained rare. The introduction of several new agents (thalidomide, lenalidomide and bortezomib) has substantially changed treatment strategies in the transplant setting. The addition of novel agents before and/or after HDT/ASCT has dramatically increased the post-ASCT complete response (CR) rate and the CR plus very good partial response (VGPR) rate.6,7 Maybe more importantly, the level of CR has been up-graded with the achievement of stringent CR (s-CR) with a normal κ/λ ratio (serum free light chain assessment), 8 of immunophenotypic CR (with multiparameter flow cytome...

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Toxicity of a second autologous peripheral blood stem cell transplant in patients with relapsed or recurrent multiple myeloma

Cited by 41 publications

References 22 publications

Multiple Myeloma, Version 3.2017, NCCN Clinical Practice Guidelines in Oncology

Multiple Myeloma, Version 3.2017, NCCN Clinical Practice Guidelines in Oncology

Second auto-SCT for treatment of relapsed multiple myeloma

Treatment of autologous stem cell transplant-eligible multiple myeloma patients: ten questions and answers

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