title: Factors influencing the outcome of a second autologous stem cell transplant (ASCT) in relapsed multiple myeloma: a study from the British Society of Blood and Marrow Transplantation Registry.
abstract: Autologous stem cell transplant as primary (first ASCT) therapy in multiple myeloma (MM) is standard practice. The role of a second ASCT as management of relapsed disease remains uncertain. We conducted a retrospective case-matched control analysis on patients (n = 106) who underwent a second ASCT compared with conventional chemotherapy (CCT) as for relapsed MM. The median age was 53 years (range: 26-75) and median follow-up 48 months (range: 8, 136). The cumulative incidence of 1 and 5 years nonrelapse mortality (NRM) was 7% (95% confidence interval [CI] 3%-13%) and 12% (95% CI 7%-19%), with a second ASCT inducing a greater partial remission (PR) rate of 63%. The 4-year overall survival (OS) rate was 33% (95% CI 24%-45%). Factors associated with improved OS and progression-free survival (PFS) included younger age (<55 years), β(2)MG <2.5 mg/L at diagnosis, a remission duration of >9 months from first ASCT, and a greater PR in response to their first ASCT. In a matched-cohort analysis with patients receiving conventional chemotherapy (CCT), the same factors were associated with improved OS, with the exception of a longer remission duration (>18 months) from first ASCT. Second ASCT in relapsed MM is associated with superior OS and PFS compared with CCT, offering a potential consolidative option for selected patients.
authors.affiliation: St. James's Institute of Oncology, Leeds Teaching Hospitals Trust, Leeds, United Kingdom. Gordon.Cook@leedsth.nhs.uk
authors.forename: Gordon
authors.initials: G
authors.lastname: Cook
authors.forename: Effie
authors.initials: E
authors.lastname: Liakopoulou
authors.forename: Rachel
authors.initials: R
authors.lastname: Pearce
authors.forename: Jim
authors.initials: J
authors.lastname: Cavet
authors.forename: Gareth J
authors.initials: GJ
authors.lastname: Morgan
authors.forename: Keiren
authors.initials: K
authors.lastname: Kirkland
authors.forename: Julia
authors.initials: J
authors.lastname: Lee
authors.forename: Faith E
authors.initials: FE
authors.lastname: Davies
authors.forename: Rachel
authors.initials: R
authors.lastname: Hall
authors.forename: Amin
authors.initials: A
authors.lastname: Rahemtulla
authors.forename: Nigel
authors.initials: N
authors.lastname: Russell
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000379:methods*; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome; D006113:United Kingdom