Page 169 - 2019_02-Haematologica-web

Outcome in MM after allo-SCT
AB
CD
Figure 1. Outcome analysis of the entire cohort. (A) Kaplan-Meier estimates for overall survival (OS). (B) Kaplan-Meier estimates for progression-free survival (PFS). (C) Cumulative incidence of relapse rate (RR). (D) Cumulative incidence of non-relapse mortality (NRM). y: year; allo-SCT: allogeneic stem cell transplantation; CI: Confidence Interval.
ed as cumulative incidence rates using Aalen Johansen estimator27 and compared with Fine and Gray regression models for compet- ing risks.28 P<0.05 was considered statistically significant. Prognostic factors were investigated in bivariate regression models adjusting for the time point of allo-SCT.
Results
Patients’ characteristics
Median patients’ age was 56 years (range 30-70) with a balanced male:female ratio. Most patients had been diag- nosed with MM; 3 had plasma cell leukemia. In 42%, allo- SCT was planned as first-line treatment due to a high-risk constellation according to cytogenetic analysis, International Staging System (ISS) and/or lack of response to prior treatment,29 mostly following a prior auto-SCT and within the DSMM protocols (87%). The majority were treated in terms of individual salvage attempts due to relapsed/refractory disease after extensive pre-treat- ment. A complete cytogenetic analysis was performed in 52% (57 of 109); another 30% were examined for deletion 13q14 only.
Twenty-five out of those 57 patients (44%) analyzed according to the current IMWG-consensus30 showed high- risk cytogenetics with a non-hyperdiploid karyotype or detection of one of the following chromosomal aberra- tions: translocation (4;14), (14;16) or (14;20) or deletion 17p, respectively. Eight of 57 (14%) had poor risk cytoge-
netics due to detection of gain 1q or deletion 1p. Four of 57 (7%) were classified in the ultra-high risk-group with three or more of those chromosomal aberrations.30
Forty of 109 (37% of the total cohort) had high-risk dis- ease according to the ISS with a beta (β)2-microglobulin ≥5.5 mg/L (ISS III). The risk profile according to the ISS and cytogenetics of patients treated in first-line and those with relapsed/refractory disease was similar.
As the observation period was long (17 years), sum- ming up a heterogenous cohort due to changes in thera- peutical concepts over time, we additionally compared three patient subgroups to distinguish between those with allo-SCT performed between 2000-2004, 2005-2009 or 2010-1016. There was no substantial difference in patients’ characteristics between these groups; however, in the latest cohort, slightly more patients were transplant- ed due to relapsed/refractory disease. As expected, com- plete cytogenetic analyses were mainly performed in recent years. Patients’ characteristics are summarized in Table 1.
At the time point of allo-SCT, 28% of the patients showed evidence of progressive disease (PD). The majori- ty proceeded to allo-SCT after sufficient response to prior treatment: 12% complete remissions (CR), 14% very good partial remissions (vgPR), 25% PR, 21% stable dis- eases (SD), and 1% minimal responses (MR). Patients underwent a median of three treatment lines prior to allo- SCT (range 1-8). As we analyzed data of patients treated between 2000 and 2017, only 50% versus 43% received
haematologica | 2019; 104(2)
373