Tandem autologous stem cell transplantation improves outcome in newly diagnosed multiple myeloma with extramedullary disease and high-risk cytogenetics: a study from the chronic malignancies working party of ebmt - Université de Lille Accéder directement au contenu
Article Dans Une Revue Biology of Blood and Marrow Transplantation Année : 2019

Tandem autologous stem cell transplantation improves outcome in newly diagnosed multiple myeloma with extramedullary disease and high-risk cytogenetics: a study from the chronic malignancies working party of ebmt

Nico Gagelmann
  • Fonction : Auteur
Diderik-Jan Eikema
  • Fonction : Auteur
Linda Koster
  • Fonction : Auteur
Denis Caillot
  • Fonction : Auteur
Pietro Pioltelli
  • Fonction : Auteur
Juan Bargay Lleonart
  • Fonction : Auteur
Peter Remenyi
  • Fonction : Auteur
Didier Blaise
Nicolaas Schaap
  • Fonction : Auteur
Marek Trneny
  • Fonction : Auteur
Jakob Passweg
  • Fonction : Auteur
Rocio Parody Porras
  • Fonction : Auteur
Jean-Yves Cahn
  • Fonction : Auteur
Maurizio Musso
  • Fonction : Auteur
Xavier Poire
  • Fonction : Auteur
Roland Fenk
  • Fonction : Auteur
Maija Itala-Remes
  • Fonction : Auteur
Vincenzo Pavone
  • Fonction : Auteur
Loic Fouillard
  • Fonction : Auteur
Johan Maertens
  • Fonction : Auteur
Dominique Bron
  • Fonction : Auteur
Anastasia Pouli
  • Fonction : Auteur
Wilfried Schroyens
  • Fonction : Auteur
Stefan Schonland
  • Fonction : Auteur
Laurent Garderet
  • Fonction : Auteur
Nicolaus Kroger
  • Fonction : Auteur

Résumé

Although high-dose therapy and autologous stem cell transplant combined with novel agents continues to be the hallmark of first-line treatment in newly diagnosed transplant-eligible multiple myeloma patients, the impact of tandem autologous or autologous/reduced-intensity allogeneic transplant for patients with extramedullary disease (EMD) and high-risk cytogenetics is not yet defined. Here, we analyzed clinical and cytogenetic data from 488 adult myeloma patients with EMD undergoing single autologous (n = 373), tandem autologous (n = 84), or autologous-allogeneic transplant (n = 31) between 2003 and 2015. At least 1 high-risk abnormality was present in 41% (n = 202), with del(17p) (40%) and t(4;14) (45%) the most frequent. More than 1 high-risk abnormality was found in 54%. High-risk cytogenetics showed worse 4-year overall survival (OS) and progression-free survival (PFS) of 54% and 29%, respectively, versus 78% and 49% for standard-risk cytogenetics (P < .001). Co-segregation of high-risk abnormalities did not seem to affect outcome. Regarding transplant regimen, OS and PFS were 70% and 43% for single autologous versus 83% and 52% for tandem autologous and 88% and 58% for autologous-allogeneic (P = .06 and P = .30). In multivariate analysis high-risk cytogenetics were associated with worse survival (hazard ratio [HR], 2.00; P = .003), whereas tandem autologous significantly improved outcome versus single autologous transplant (HRs, .46 and .64; P = .02 and P = .03). Autologous-allogeneic transplant did not significantly differ in outcome but appeared to improve survival, but results were limited because of small population (HR, .31). In conclusion, high-risk cytogenetics is frequently observed in newly diagnosed myeloma with EMD and significantly worsens outcome after single autologous, whereas a tandem autologous transplant strategy may overcome onset poor prognosis.

Dates et versions

hal-04429160 , version 1 (31-01-2024)

Identifiants

Citer

Nico Gagelmann, Diderik-Jan Eikema, Linda Koster, Denis Caillot, Pietro Pioltelli, et al.. Tandem autologous stem cell transplantation improves outcome in newly diagnosed multiple myeloma with extramedullary disease and high-risk cytogenetics: a study from the chronic malignancies working party of ebmt. Biology of Blood and Marrow Transplantation, 2019, Biology of Blood and Marrow Transplantation, 25, pp.2134-2142. ⟨10.1016/j.bbmt.2019.07.004⟩. ⟨hal-04429160⟩

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