Salvage Autologous Hematopoietic Stem Cell Transplantation Versus Chemoimmunotherapy in Relapsed Multiple Myeloma Patients After First Transplantation; Single Center Data
Abstract
Objectives: Multiple myeloma (MM) is an uncurable disease and standard therapy for relapsed MM is still not clear. We aimed to compare salvagetreatments for relapsed refractory MM.
Materials and Methods: Sixty patients who relapsed after first autologous stem cell transplantation (ASCT) were analyzed. Twenty-seven patients were treated with salvage chemoimmunotherapy (CIT). Thirty-three were treated with salvage ASCT.
Results: There was no difference between treatment arms in terms of gender, age and disease characteristics. Median progression-free survival (PFS) was significantly better in ASCT group than CIT group (25 months vs. 12 months; p=0.01). PFS rates on the first and second year were also better in ASCT group. Median overall survival in ASCT group was longer than CIT (73 vs. 30 months), although it did not reach a statistical significance (p=0.09). Time to achieving the best response after ASCT and CIT was 1 (0-9) month versus 6.5 (2-15) months (p=0.02). All grade toxicities were similar in both groups (ASCT 57.6% vs. CIT 48.1%) (p=0.6). Grade 3 or 4 toxicities were similar (ASCT 19%, CIT 13%) in both groups (p=0.4). In the approximate cost analysis made with current pricing in December 2022 in our country, ASCT was more economical than CIT (380 600 € vs. 393 860 €).
Conclusion: Salvage ASCT may provide longer PFS with similar toxicity profile and more cost-effective therapy profile than salvage CIT. It is
suggested that earlier and better responses, long-term PFS can be achieved with salvage ASCT.
Keywords
Multiple Myeloma, Relapsed, Salvage Transplantation, Chemoimmunotherapy, Second Autologous, Stem Cell Transplantation
Ethical Statement
Ethics Committee Approval: Ethics Committee approval was received from Gazi University with the number 77082166- 302.08.01.
Informed Consent: Retrospective study.
Peer-review: Externally and internally peer-reviewed.
References
- 1. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022. CA Cancer J Clin. 2022;72:7-33.
- 2. Cowan AJ, Allen C, Barac A, et al. Global Burden of Multiple Myeloma: A Systematic Analysis for the Global Burden of Disease Study 2016. JAMA Oncol. 2018;4:1221-1227.
- 3. Blocka J, Hielscher T, Mueller-Tidow C, et al. Salvage therapy versus upfront autologous stem cell transplantation in multiple myeloma patients with progressive disease after first-line induction therapy. Leuk Lymphoma. 2020;61:27-36.
- 4. Poczta A, Rogalska A, Marczak A. Treatment of Multiple Myeloma and the Role of Melphalan in the Era of Modern Therapies-Current Research and Clinical Approaches. J Clin Med. 2021;10:1841.
- 5. Cavo M, Gay F, Beksac M, et al. Autologous haematopoietic stem-cell transplantation versus bortezomib-melphalan-prednisone, with or without bortezomib-lenalidomide-dexamethasone consolidation therapy, and lenalidomide maintenance for newly diagnosed multiple myeloma (EMN02/HO95): a multicentre, randomised, open-label, phase 3 study. Lancet Haematol. 2020;7:456-468.
- 6. Gentile M, Morabito F, Martino M, et al. Chemotherapy-based regimens inmultiple myeloma in 2020. Panminerva Med. 2021;63:7-12.
- 7. Blimark CH, Turesson I, Genell A, et al. Outcome and survival of myelomapatients diagnosed 2008-2015. Real-world data on 4904 patients from the Swedish Myeloma Registry. Haematologica. 2018;103:506-513.
- 8. Bygrave CA, Pawlyn C, Davies FE, et al. Progression Free Survival below 12 Months Following Stem Cell Transplant Is a Hallmark of High-Risk Myeloma Which Is Associated with Inferior Overall Survival — Data fromthe Ukmrc Myeloma XI Trial. Blood. 2018;132:122.
- 9. Goldschmidt H, Baertsch MA, Schlenzka J, et al. Salvage autologous transplant and lenalidomide maintenance vs. lenalidomide/dexamethasone for relapsed multiple myeloma: the randomized GMMG phase III trial ReLApsE. Leukemia. 2021;35:1134-1144.
- 10. Dhakal B, D’Souza A, Kleman A, et al. Salvage second transplantation in relapsed multiple myeloma. Leukemia. 2021;35:1214-1217.