Outcomes of a late second autologous hematopoietic stem cell transplant compared to nontransplantation salvage therapy in relapsed multiple myeloma after upfront transplant.

Abstract

8071 Background: A second late autologous hematopoietic stem cell transplant (ASCT) has been considered as an option for patients with multiple myeloma (MM) who have relapsed after previous high-dose chemotherapy performed as part of upfront therapy. The relative benefit of a late second ASCT compared to nontransplantation salvage therapy is currently unknown. Methods: The study included 270 consecutive MM patients who relapsed after upfront ASCT, treated at Indiana University Simon Cancer Center from 1999 till 2009. 19 patients received a late second ASCT for relapsed disease. Most patients in both groups received post-relapse salvage therapy with thalidomide, lenalidomide, and bortezomib. Survival was calculated from the time of the first relapse post upfront ASCT. Univariate analysis was done to analyze the effect on overall survival of: stage, number of prior therapies (<3 vs. ≥ 3), duration of first response, age at diagnosis, hemoglobin (< 10 vs. ≥ 10), calcium (< 11 vs. ≥ 11), albumin (<3.5 vs. ≥3.5), and beta-2 microglobulin (<5.5 vs. ≥ 5.5). Results: The median duration between the first and second transplant was 40.4 months. There was no statistically significant difference between both groups in baseline characteristics (Table). The number of salvage treatments post-relapse was comparable (Table).The median survival was 6.4 years in the single ASCT group vs. 5.2 years in the second ASCT group (p = 0.8048). The 3-year survival probability was 73% for the single transplant group and 88% for the late second ASCT group. Stage was not significant in predicting survival time (p = 0.1430) nor was the number of transplants (p = 0.8048). In the univariate analysis, only the duration of first remission was found to be significant (p < 0.0001) independently from the management group. Conclusions: A late second ASCT does not seem to impact survival of patients with relapsed MM. Baseline characteristics Single ASCT Late second ASCT No of salvage treatments 2.9 (0-8) 2.6 (1-4) Duration of first remission 1.5 (0.2-4.5) 1.7 (0.4-4.4) Age 56 (25-73) 54 (38-73) Albumin 3.7 (1.7-13.8) 3.9 (3.2-4.5) Beta2 microglobulin 5.6 (0.6-27.6) 8.7 (2.2-28.4)