Prognostic factors for postrelapse survival after ex vivo CD34(+)-selected (T cell-depleted) allogeneic hematopoietic cell transplantation in multiple myeloma Journal Article
| Authors: | Gomez-Arteaga, A.; Shah, G. L.; Baser, R. E.; Scordo, M.; Ruiz, J. D.; Bryant, A.; Dahi, P. B.; Ghosh, A.; Lahoud, O. B.; Landau, H. J.; Landgren, O.; Shaffer, B. C.; Smith, E. L.; Koehne, G.; Perales, M. A.; Giralt, S. A.; Chung, D. J. |
| Article Title: | Prognostic factors for postrelapse survival after ex vivo CD34(+)-selected (T cell-depleted) allogeneic hematopoietic cell transplantation in multiple myeloma |
| Abstract: | Allogeneic hematopoietic cell transplantation (alloHCT) for multiple myeloma (MM), with its underlying graft-versus-tumor capacity, is a potentially curative approach for high-risk patients. Relapse is the main cause of treatment failure, but predictors for postrelapse survival are not well characterized. We conducted a retrospective analysis to evaluate predictors for postrelapse overall survival (OS) in 60 MM patients who progressed after myeloablative T cell-depleted alloHCT. The median patient age was 56 years, and 82% had high-risk cytogenetics. Patients received a median of 4 lines of therapy pre-HCT, and 88% achieved at least a partial response (PR) before alloHCT. Of the 38% who received preemptive post-HCT therapy, 13 received donor lymphocyte infusions (DLIs) and 10 received other interventions. Relapse was defined as very early (<6 months; 28%), early (6 to 24 months; 50%), or late (>24 months; 22%). At relapse, 27% presented with extramedullary disease (EMD). The median postrelapse overall survival (OS) by time to relapse was 4 months for the very early relapse group, 17 months for the early relapse group, and 72 months for the late relapse group (P = .002). Older age, relapse with EMD, <PR before alloHCT, <PR by day +100, and no maintenance were prognostic for inferior postrelapse OS on univariate analysis. On multivariate analysis adjusted for age and sex, very early relapse (hazard ratio [HR], 4.37; 95% confidence interval [CI], 1.42 to 13.5), relapse with EMD (HR, 5.20; 95% CI, 2.10 to 12.9), and DLI for relapse prevention (HR, .11; 95% CI, 2.10 to 12.9) were significant predictors for postrelapse survival. Despite their shared inherent high-risk status, patients with MM have significantly disparate post-HCT relapse courses, with some demonstrating long-term survival despite relapse. © 2020 American Society for Transplantation and Cellular Therapy |
| Keywords: | multiple myeloma; relapse; donor lymphocyte infusion; allogeneic hematopoietic stem cell transplantation; t cell depletion; cd34+ selection |
| Journal Title: | Biology of Blood and Marrow Transplantation |
| Volume: | 26 |
| Issue: | 11 |
| ISSN: | 1083-8791 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2020-11-01 |
| Start Page: | 2040 |
| End Page: | 2046 |
| Language: | English |
| DOI: | 10.1016/j.bbmt.2020.07.016 |
| PUBMED: | 32712326 |
| PROVIDER: | scopus |
| PMCID: | PMC7609585 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 December 2020 -- Source: Scopus |
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