Page 166 - 2019_02-Haematologica-web

Ferrata Storti Foundation
Haematologica 2019 Volume 104(2):370-379
Plasma Cell Disorders
Allogeneic transplantation of multiple myeloma patients may allow long-term survival in carefully selected patients with acceptable toxicity and preserved quality of life
Christine Greil,1 Monika Engelhardt,1 Gabriele Ihorst,2 Katja Schoeller,1 Hartmut Bertz,1 Reinhard Marks,1 Robert Zeiser,1 Justus Duyster,1 Hermann Einsele,3 Jürgen Finke1 and Ralph Wäsch1
1Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine; 2Clinical Trials Unit, Faculty of Medicine, University of Freiburg and 3Department of Internal Medicine II, University Hospital of Würzburg, Germany
ABSTRACT
Despite significantly improved survival and response rates in patients diagnosed with multiple myeloma, it still remains an incurable disease with a poor outcome, especially in high-risk groups. Allogeneic stem cell transplantation offers a potentially curative option but remains controversial due to considerable treatment-related toxicity. We analyzed 109 consecutive myeloma patients who had received reduced-intensity conditioning allogeneic transplantation at the Freiburg University Medical Center between 2000 and 2016. Although most patients were heavily pre-treated in high-risk constellations, the overall response rate was high with 70%, the median overall survival (OS) 39.2%, and the median progression-free survival (PFS) 14.2 months, with a median follow up of 71.5 months. Survival was significantly bet- ter in patients with response to previous therapies than in those with progressive disease (median OS 65 vs. 11.5 months, P=0.003; median PFS 18.4 vs. 5.1 months, P=0.001). Moreover, survival of patients transplant- ed in first-line was significantly prolonged compared to relapsed/refrac- tory disease (median OS not reached vs. 21.6 months, P<0.001; median PFS 47.7 vs. 9.6 months, P<0.001). The non-relapse mortality was rela- tively low with a cumulative incidence of 12.4% at ten years. Acute graft-versus-host disease (GvHD) grade II-IV was observed in 25%, and moderate or severe chronic GvHD in 24%. Quality of life (QoL) assessed with the revised Myeloma Comorbidity Index before and after trans- plantation remained unchanged. Our data suggest that allogeneic trans- plantation in the context of novel immunotherapeutic approaches may enable long-term survival and even a potential cure in a carefully selected subgroup of high-risk multiple myeloma patients with acceptable toxic- ity and preserved QoL.
Introduction
Despite a remarkable increase in effective treatment options, multiple myeloma (MM) still remains mostly incurable. Nevertheless, survival of patients diagnosed with MM has significantly improved over the last few years, although outcome may be poor with a median overall survival (OS) of only 2-3 years in subgroups of patients with higher stage and high-risk cytogenetics.1,2
Allogeneic stem cell transplantation (allo-SCT) may help to achieve long-term pro- gression-free survival (PFS) and offers a potentially curative option due to a graft-ver- sus-myeloma (GvM) effect.3 However, allo-SCT remains controversial because of considerable toxicity, especially due to immunosuppression and subsequent infec- tions, the risk of graft-versus-host disease (GvHD), and thus a potentially high non- relapse mortality (NRM).4 Although in general allo-SCT is not routinely conducted
Correspondence:
ralph.waesch@uniklinik-freiburg.de
Received: June 29, 2018.
Accepted: September 14, 2018. Pre-published: September 20, 2018.
doi:10.3324/haematol.2018.200881
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/104/2/370
©2019 Ferrata Storti Foundation
Material published in Haematologica is covered by copyright. All rights are reserved to the Ferrata Storti Foundation. Use of published material is allowed under the following terms and conditions: https://creativecommons.org/licenses/by-nc/4.0/legalcode. Copies of published material are allowed for personal or inter- nal use. Sharing published material for non-commercial pur- poses is subject to the following conditions: https://creativecommons.org/licenses/by-nc/4.0/legalcode, sect. 3. Reproducing and sharing published material for com- mercial purposes is not allowed without permission in writing from the publisher.
370
haematologica | 2019; 104(2)
ARTICLE