title: Treatment options for relapse after autograft in multiple myeloma - report from an EBMT educational meeting.
abstract: Major improvements have been made in the treatment of myeloma. However, all patients, perhaps with some exceptions, eventually relapse, even after autologous stem cell transplantation (ASCT). In that setting, the combinations of new drugs, namely the IMiDs and the proteasome inhibitors along with steroids, give encouraging results in relapsed patients. The median progression-free survival (PFS) is 20 months with lenalidomide plus dexamethasone plus ixazomib and 26 months with lenalidomide plus dexamethasone plus carfilzomib. Monoclonal antibodies have emerged as an additional new treatment option. The antibody anti-SLAMF7, elotuzumab, in combination with lenalidomide plus dexamethasone gives a median PFS of 20 months. The antibody daratumumab, targeting CD38, alone has an outstanding activity in previously heavily treated patients. Its use in combination is ongoing. Transplantation remains a major treatment option. For patients who relapse at least 18 months from the initial ASCT, a second ASCT can be performed with an expected time to progression of 19 months from the time of transplantation. For patients relapsing earlier and/or with high-risk characteristics and who are still chemosensitive, with a suitable donor, an allogeneic transplantation can be considered. The optimal treatment combination and sequence remain to be determined.
authors.affiliation: a INSERM, UMR_S 938, Proliferation and differentiation of stem cells , Paris , France.|b AP-HP, Hôpital Saint Antoine, Département d'hématologie et de thérapie cellulaire , Paris , France , Université Pierre et Marie Curie-Paris6.
authors.forename: Laurent
authors.initials: L
authors.lastname: Garderet
authors.affiliation: c Leeds Institute of Cancer and Pathology , University of Leeds , UK.
authors.forename: Gordon
authors.initials: G
authors.lastname: Cook
authors.affiliation: d Department of Medicine , Imperial College London , London , UK.
authors.forename: Holger W
authors.initials: HW
authors.lastname: Auner
authors.affiliation: e Department of Oncology, A.O.U. Città della Salute e della Scienza di Torino , Torino , Italy.|f Department of Molecular Biotechnology and Health Sciences , University of Torino , Torino , Italy.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Bruno
authors.affiliation: g Department of Hematology , VU University Medical Center De Boelelaan , Amsterdam , the Netherlands.
authors.forename: Henk
authors.initials: H
authors.lastname: Lokhorst
authors.affiliation: h Department of Hematology , University Hospital Virgen del Rocio/Instituto de Biomedicina (IBIS)/CSIC , Seville , Spain.
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Perez-Simon
authors.affiliation: i Division of Hematology/Hematopoietic Stem Cell Transplantation City of Hope Medical Center/So. California Permanente Medical Group , Duarte, CA , USA.
authors.forename: Firoozeh
authors.initials: F
authors.lastname: Sahebi
authors.affiliation: j Department I of Internal Medicine , University Hospital of Cologne Kerpener , Cologne , Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Scheid
authors.affiliation: k The Queens University Belfast CCRCB , Belfast , Northern Ireland.
authors.forename: Curly
authors.initials: C
authors.lastname: Morris
authors.affiliation: l EBMT Data Office Leiden, Department of Medical Statistics & Bioinformatics, S-05-P , Leiden University Medical Center , Leiden , the Netherlands.
authors.forename: Anja
authors.initials: A
authors.lastname: van Biezen
authors.affiliation: m Blood and Marrow Transplantation Unit, Department of Hematology 1G , Université Claude Bernard Lyon 1 Pierre Bénite , France.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Sobh
authors.affiliation: m Blood and Marrow Transplantation Unit, Department of Hematology 1G , Université Claude Bernard Lyon 1 Pierre Bénite , France.
authors.forename: Mauricette
authors.initials: M
authors.lastname: Michallet
authors.affiliation: n Department of Medicine , Karolinska Institutet , Huddinge , Stockholm , Sweden.
authors.forename: Gösta
authors.initials: G
authors.lastname: Gahrton
authors.affiliation: o Department of Internal Medicine V, Hematology, Oncology and Rheumatology , Amyloidosis Center, University Hospital Heidelberg , Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schönland
authors.affiliation: p Department of Stem Cell Transplantation University Hospital Hamburg-Eppendorf Martinistrasse , Hamburg , Germany.
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Kröger
mesh_terms: D003131:Combined Modality Therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D009101:Multiple Myeloma / Q000473:pathology* / Q000628:therapy*; D012008:Recurrence; D019233:Retreatment; D014182:Transplantation, Autologous
keywords: Myeloma; allogeneic stem cell transplantation; autologous stem cell transplantation; immunomodulatory drugs; monoclonal antibodies; proteasome inhibitors; relapse