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

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