title: American Society of Blood and Marrow Transplantation, European Society of Blood and Marrow Transplantation, Blood and Marrow Transplant Clinical Trials Network, and International Myeloma Working Group Consensus Conference on Salvage Hematopoietic Cell Transplantation in Patients with Relapsed Multiple Myeloma.
abstract: In contrast to the upfront setting in which the role of high-dose therapy with autologous hematopoietic cell transplantation (HCT) as consolidation of a first remission in patients with multiple myeloma (MM) is well established, the role of high-dose therapy with autologous or allogeneic HCT has not been extensively studied in MM patients relapsing after primary therapy. The International Myeloma Working Group together with the Blood and Marrow Transplant Clinical Trials Network, the American Society of Blood and Marrow Transplantation, and the European Society of Blood and Marrow Transplantation convened a meeting of MM experts to: (1) summarize current knowledge regarding the role of autologous or allogeneic HCT in MM patients progressing after primary therapy, (2) propose guidelines for the use of salvage HCT in MM, (3) identify knowledge gaps, (4) propose a research agenda, and (5) develop a collaborative initiative to move the research agenda forward. After reviewing the available data, the expert committee came to the following consensus statement for salvage autologous HCT: (1) In transplantation-eligible patients relapsing after primary therapy that did NOT include an autologous HCT, high-dose therapy with HCT as part of salvage therapy should be considered standard; (2) High-dose therapy and autologous HCT should be considered appropriate therapy for any patients relapsing after primary therapy that includes an autologous HCT with initial remission duration of more than 18 months; (3) High-dose therapy and autologous HCT can be used as a bridging strategy to allogeneic HCT; (4) The role of postsalvage HCT maintenance needs to be explored in the context of well-designed prospective trials that should include new agents, such as monoclonal antibodies, immune-modulating agents, and oral proteasome inhibitors; (5) Autologous HCT consolidation should be explored as a strategy to develop novel conditioning regimens or post-HCT strategies in patients with short (less than 18 months remissions) after primary therapy; and (6) Prospective randomized trials need to be performed to define the role of salvage autologous HCT in patients with MM relapsing after primary therapy comparing it to "best non-HCT" therapy. The expert committee also underscored the importance of collecting enough hematopoietic stem cells to perform 2 transplantations early in the course of the disease. Regarding allogeneic HCT, the expert committee agreed on the following consensus statements: (1) Allogeneic HCT should be considered appropriate therapy for any eligible patient with early relapse (less than 24 months) after primary therapy that included an autologous HCT and/or high-risk features (ie, cytogenetics, extramedullary disease, plasma cell leukemia, or high lactate dehydrogenase); (2) Allogeneic HCT should be performed in the context of a clinical trial if possible; (3) The role of postallogeneic HCT maintenance therapy needs to be explored in the context of well-designed prospective trials; and (4) Prospective randomized trials need to be performed to define the role salvage allogeneic HCT in patients with MM relapsing after primary therapy.
authors.affiliation: Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: giralts@mskcc.org.
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
authors.affiliation: Hospital St Antoine, INSERM UMR_S 938, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Garderet
authors.affiliation: International Myeloma Foundation, Los Angeles, California.
authors.forename: Brian
authors.initials: B
authors.lastname: Durie
authors.affiliation: St. James University Hospital, Leed, United Kingdom.
authors.forename: Gordon
authors.initials: G
authors.lastname: Cook
authors.affiliation: Karolinska Institute, Huddinge, Sweden.
authors.forename: Gosta
authors.initials: G
authors.lastname: Gahrton
authors.affiliation: Universita Degli Studi di Torini, Torino, Italy.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Bruno
authors.affiliation: Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Paremesweran
authors.initials: P
authors.lastname: Hari
authors.affiliation: University Medical Center Utrecht, Netherlands.
authors.forename: Henk
authors.initials: H
authors.lastname: Lokhorst
authors.affiliation: Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Phillip
authors.initials: P
authors.lastname: McCarthy
authors.affiliation: City of Hope Cancer Center Duarte, California.
authors.forename: Amrita
authors.initials: A
authors.lastname: Krishnan
authors.affiliation: Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: Pieter
authors.initials: P
authors.lastname: Sonneveld
authors.affiliation: University of Heidelberg, Heidelberg, Germany.
authors.forename: Harmut
authors.initials: H
authors.lastname: Goldschmidt
authors.affiliation: Mount Sinai School of Medicine, New York, New York.
authors.forename: Sundar
authors.initials: S
authors.lastname: Jagannath
authors.affiliation: Mount Sinai School of Medicine, New York, New York.
authors.forename: Bart
authors.initials: B
authors.lastname: Barlogie
authors.affiliation: Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Mateos
authors.affiliation: Rigshospitalet, Copenhagen, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Gimsing
authors.affiliation: Memorial Sisli Hastanesi, Istanbul, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Sezer
authors.affiliation: Mayo Clinic Scottsdale, Scottsdale, Arizona.
authors.forename: Joseph
authors.initials: J
authors.lastname: Mikhael
authors.affiliation: Peking University Institute of Hematology, People's Hospital, Beijing, Peoples Republic of China.
authors.forename: Jin
authors.initials: J
authors.lastname: Lu
authors.affiliation: National and Kapodistrian University of Athens Alexandra Hospital, Athens, Greece.
authors.forename: Meletios
authors.initials: M
authors.lastname: Dimopoulos
authors.affiliation: New York University School of Medicine, New York, New York.
authors.forename: Amitabha
authors.initials: A
authors.lastname: Mazumder
authors.affiliation: University of Torino, Torino, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Palumbo
authors.affiliation: Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana.
authors.forename: Rafat
authors.initials: R
authors.lastname: Abonour
authors.affiliation: Dana Farber Cancer Institute, Harvard University, Boston, Massachusetts.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Anderson
authors.affiliation: Institut Claudius Regaud, Toulouse, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Attal
authors.affiliation: Hospital Clinic, IDIBAPS, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Blade
authors.affiliation: University Hospital Bristol, Bristol, United Kingdom.
authors.forename: Jenny
authors.initials: J
authors.lastname: Bird
authors.affiliation: Seragnoli Institut of Hematology, Bologna University School of Medicine, Bologna, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Cavo
authors.affiliation: Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Raymond
authors.initials: R
authors.lastname: Comenzo
authors.affiliation: Hospital Dr. Pesset, Valencia, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: de la Rubia
authors.affiliation: Klinik der Universität Würzburg, Würzburg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Einsele
authors.affiliation: Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: Ramon
authors.initials: R
authors.lastname: Garcia-Sanz
authors.affiliation: University of Heidelberg, Heidelberg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Hillengass
authors.affiliation: Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Sarah
authors.initials: S
authors.lastname: Holstein
authors.affiliation: Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Johnsen
authors.affiliation: Royal Prince Alfred Hospital, Sydney University Medical School, Sydney, Australia.
authors.forename: Douglas
authors.initials: D
authors.lastname: Joshua
authors.affiliation: Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Guenther
authors.initials: G
authors.lastname: Koehne
authors.affiliation: Mayo Clinic Rochester, Rochester, Minnesota.
authors.forename: Shaji
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Mayo Clinic Rochester, Rochester, Minnesota.
authors.forename: Robert
authors.initials: R
authors.lastname: Kyle
authors.affiliation: Hospital Claude Huriez, Lille, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Leleu
authors.affiliation: Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia.
authors.forename: Sagar
authors.initials: S
authors.lastname: Lonial
authors.affiliation: Wilhelminenkrebsforschungsinstituts, Vienna, Austria.
authors.forename: Heinz
authors.initials: H
authors.lastname: Ludwig
authors.affiliation: Karolinska Institute, Huddinge, Sweden.
authors.forename: Hareth
authors.initials: H
authors.lastname: Nahi
authors.affiliation: Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia.
authors.forename: Anil
authors.initials: A
authors.lastname: Nooka
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Robert
authors.initials: R
authors.lastname: Orlowski
authors.affiliation: Mayo Clinic Rochester, Rochester, Minnesota.
authors.forename: Vincent
authors.initials: V
authors.lastname: Rajkumar
authors.affiliation: Dalhousie University Medical School, Dalhousie, Nova Scotia, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Reiman
authors.affiliation: Dana Farber Cancer Institute, Harvard University, Boston, Massachusetts.
authors.forename: Paul
authors.initials: P
authors.lastname: Richardson
authors.affiliation: Hospital de Clinicas, Montevideo, Uruguay.
authors.forename: Eloisa
authors.initials: E
authors.lastname: Riva
authors.affiliation: Clinica Universidad de Navarra, Navarra, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: San Miguel
authors.affiliation: Skane University Hospital, Malmo, Sweden.
authors.forename: Ingemar
authors.initials: I
authors.lastname: Turreson
authors.affiliation: Levine Cancer Institute, Charlotte, North Carolina.
authors.forename: Saad
authors.initials: S
authors.lastname: Usmani
authors.affiliation: John Theurer Cancer Center, Hackensack, New Jersey.
authors.forename: David
authors.initials: D
authors.lastname: Vesole
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: William
authors.initials: W
authors.lastname: Bensinger
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Qazilbash
authors.affiliation: Ohio State University Medical Center, Columbus, Ohio.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Efebera
authors.affiliation: University Marie and Pierre Curie, Hospital St Antoine, Paris, France.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mohty
authors.affiliation: Duke University Hospital, Durham, North Carolina.
authors.forename: Christina
authors.initials: C
authors.lastname: Gasparreto
authors.affiliation: Oregon Health Sciences University, Portland, Oregon.
authors.forename: James
authors.initials: J
authors.lastname: Gajewski
authors.affiliation: Sarah Cannon Research Institute, Nashville, Tennesee.
authors.forename: Charles F
authors.initials: CF
authors.lastname: LeMaistre
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Bredeson
authors.affiliation: University Hospital Nantes, Nantes, France.
authors.forename: Phillipe
authors.initials: P
authors.lastname: Moreau
authors.affiliation: Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Pasquini
authors.affiliation: University Hospital Hamburg, Hamburg, Germany.
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Kroeger
authors.affiliation: University of Pennsylvania Abramson Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Edward
authors.initials: E
authors.lastname: Stadtmauer
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D009101:Multiple Myeloma / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D019653:Myeloablative Agonists / Q000627:therapeutic use; D061988:Proteasome Inhibitors / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012074:Remission Induction; D016879:Salvage Therapy / Q000379:methods*; D019172:Transplantation Conditioning / Q000379:methods*; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
chemical_list: D000911:Antibodies, Monoclonal; D007155:Immunologic Factors; D019653:Myeloablative Agonists; D061988:Proteasome Inhibitors
keywords: Myeloma; Salvage therapy; Stem cell transplantation