Page 170 - 2019_02-Haematologica-web

C. Greil et al.
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CD
Figure 2. Subgroup analysis of disease activity prior to allogeneic stem cell transplantation (allo-SCT). Complete remission, (very good) partial remission, partial remission, stable disease or minimal response defined as inactive disease (n=79) versus those with progressive disease defined as active disease (n=30). (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); mo: months; y: year; CI: Confidence Interval.
regimens containing PI or IMID, respectively. Ninety-two percent of the cohort received prior auto-SCT, the majori- ty of them as a single transplant; 24% had received prior auto-SCT as tandem transplant or with a second trans- plant in the case of relapse.31 In 47%, the period between auto- and allo-SCT was shorter than eight months; the median interval was 17.3 months (range 1.1-104.2). Median time between initial diagnosis (ID) and allo-SCT was 27.7 months (range 4.8-137.4). Table 2 shows MM- treatment parameters before allo-SCT. Transplant data such as HLA-compatibility of the donor, stem cell source, and CMV-status are summarized in Table 2.
Graft-versus-host disease and engraftment
Half of the cohort did not develop any sign of acute GvHD (aGvHD). In 25%, only mild symptoms occurred corresponding to aGvHD grade I, the remaining 25% were diagnosed with aGvHD grade II-IV, of whom only 10% had grade III or IV. Symptoms occurred at a median of 47 days after allo-SCT (range 3-150). In 58% of the patients, no symptoms of chronic GvHD (cGvHD) were detected; 24% suffered from moderate or severe cGvHD
(Table 3).
Hematologic recovery with an absolute neutrophil
count higher than 0.5x109/L and a platelet count higher than 20x109/L was reached at a median of 18 days (range
10-54) and 12 days (range 5-48), respectively (Table 3).
At the time point of analysis, 42% of the patients were still alive. NRM was relatively low (13%) (Table 3). Most patients died from PD with overlapping infection and/or GvHD; GvHD was the primary cause of death in only 2
patients.
Treatment response, survival after allo-stem cell transplantation and post-transplant therapy
Overall response rate was high (70%) (Table 3). At the first response evaluation conducted on day 30 after allo- SCT, 39% of the patients showed CR, 14% vgPR, and 18% PR. SD or MR was detected in 23% versus 4%, respectively, while only 3% had PD. In nearly all patients, best response to treatment had already been reached at this time point. In 4 patients, follow-up examinations revealed further improvement from vgPR to CR, leading to an overall CR rate of 42%.
Thirty-two percent received DLI after allo-SCT, nearly all due to serological PD. Only one patient was treated prophylactically because of a decreasing donor chimerism, consistent with the observation that chimerism analysis probably does not provide any further information for therapy management.32
PI and IMID were administered in the post-transplant setting in 43% and 36%, respectively, thereof only in
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haematologica | 2019; 104(2)