title: Salvage autologous stem cell transplantation for multiple myeloma relapsing or progressing after up-front autologous transplantation.
abstract: Progression or relapse occurs in the vast majority of patients with multiple myeloma (MM) who undergo up-front autologous hematopoietic cell transplantation (AHCT1), which remains a cornerstone of treatment in the era of novel agents. Limited data are available regarding the value of salvage therapy with a second AHCT (AHCT2) in patients who relapse/progress after AHCT1. We analyzed the outcome of 83 patients who underwent salvage AHCT2 between 1994 and 2011. Most patients (77%) had received treatment with novel agents between AHCT1 and AHCT2, and 28% of patients were from ethnic minority groups. Median overall survival (OS) from AHCT2 was 31.5 months (95% confidence interval [CI]: 22-41), and median progression-free survival (PFS) was 15.5 months (95% CI: 11-20). In multivariate analysis, only disease status (≥ PR) at AHCT2 was associated with better OS. The 3-year OS rates for patients receiving AHCT2 in > PR and PR were 85.9% (95% CI: 61-96) and 51.3% (95% CI: 34-68), respectively. Disease status at AHCT2 and time to progression/relapse after AHCT1 were associated with PFS in multivariate analysis. In summary, salvage AHCT2 is an effective treatment option in patients with chemosensitive relapse/progression and prolonged remission after a prior autograft.
authors: Centre for Haematology, Division of Experimental Medicine, Department of Medicine , Imperial College London, London , UK.
authors: Holger W
authors: HW
authors: Auner
authors: Richard
authors: R
authors: Szydlo
authors: Alero
authors: A
authors: Rone
authors: Aristeidis
authors: A
authors: Chaidos
authors: Chrissy
authors: C
authors: Giles
authors: Ed
authors: E
authors: Kanfer
authors: Donald H
authors: DH
authors: Macdonald
authors: David
authors: D
authors: Marin
authors: Dragana
authors: D
authors: Milojkovic
authors: Jiri
authors: J
authors: Pavlu
authors: Jane F
authors: JF
authors: Apperley
authors: Amin
authors: A
authors: Rahemtulla
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D012008:Recurrence; D016879:Salvage Therapy; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous