title: Salvage second hematopoietic cell transplantation in myeloma.
abstract: Autologous hematopoietic cell transplantation (AHCT) as initial therapy of patients with multiple myeloma (MM) improves survival. However, data to support this approach for relapsed/progressive disease after initial AHCT (AHCT1) are limited. Using Center for International Blood and Marrow Transplant Research data, we report the outcomes of 187 patients who underwent a second AHCT (AHCT2) for the treatment of relapsed/progressive MM. Planned tandem AHCT was excluded. Median age at AHCT2 was 59 years (range, 28 to 72), and median patient follow-up was 47 months (range, 3 to 97). Nonrelapse mortality after AHCT2 was 2% at 1 year and 4% at 3 years. Median interval from AHCT1 to relapse/progression was 18 months, and median interval between transplantations was 32 months. After AHCT2, the incidence of relapse/progression at 1 and 3 years was 51% and 82%, respectively. At 3 years after AHCT2, progression-free survival was 13%, and overall survival was 46%. In multivariate analyses, those relapsing ≥36 months after AHCT1 had superior progression-free (P = .045) and overall survival (P = .019). Patients who underwent AHCT2 after 2004 had superior survival (P = .026). AHCT2 is safe and feasible for disease progression after AHCT1. In this retrospective study, individuals relapsing ≥36 months from AHCT1 derived greater benefit from AHCT2 compared with those with a shorter disease-free interval. Storage of an adequate graft before AHCT1 will ensure that the option of a second autologous transplantation is retained for patients with relapsed/progressive MM.
authors.affiliation: Loyola University Medical Center, Maywood, Illinois, USA.
authors.forename: Laura C
authors.initials: LC
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authors.lastname: Holland
authors.forename: Rajneesh
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authors.lastname: Nath
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authors.forename: Angelo
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authors.lastname: Maiolino
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authors.lastname: Kassim
authors.forename: Sergio A
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authors.lastname: Landau
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authors.lastname: Kindwall-Keller
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authors.lastname: Stiff
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authors.lastname: Lonial
authors.forename: Amrita
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mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000601:surgery*; D012008:Recurrence; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome