TY - JOUR
T1 - Outcomes of Haploidentical Transplantation in Patients with Relapsed Multiple Myeloma
T2 - An EBMT/CIBMTR Report
AU - Sahebi, Firoozeh
AU - Garderet, Laurent
AU - Kanate, Abraham S.
AU - Eikema, Diderik-Jan
AU - Knelange, Nina Simone
AU - Alvelo, Omar F. Davila
AU - Koc, Yener
AU - Blaise, Didier
AU - Bashir, Qaiser
AU - Moraleda, Jose M.
AU - Dreger, Peter
AU - Sanchez, James F.
AU - Ciurea, Stefan
AU - Schouten, Harry
AU - Shah, Nirav N.
AU - Verbeekl, Mareike
AU - Roesler, Wolf
AU - Diez-Martin, Jose L.
AU - Schoenland, Stefan
AU - D'Souza, Anita
AU - Kroeger, Nicolaus
AU - Hari, Parameswaran
N1 - Funding Information:
The authors thank the bone marrow transplant coordinator's office, the physicians and nurses, and members of the bone marrow transplant service for providing outstanding care. This work was presented in part at the 44th annual meeting of the European Society for Blood and Marrow Transplantation, Lisbon, Portugal, March 18-21, 2018., Conflict of interest statement: There are no conflicts of interest to report., Authorship statement: F.S., L.G., A.D., N.K., and P.H. designed the study; D.-G.E. performed the statistical analysis; all authors analyzed the data; F.S. and J.F.S. wrote the manuscript; and all authors reviewed the manuscript.
Publisher Copyright:
© 2018
PY - 2019/2
Y1 - 2019/2
N2 - Allogeneic hematopoietic cell transplantation (allo-HCT) using siblings and matched donors has the potential for long-term disease control in a subset of high-risk patients with multiple myeloma (MM); however, the data on using haploidentical donors in this disease are limited. We conducted a retrospective analysis to examine the outcomes of patients with MM who underwent haploidentical allo-HCT within European Society for Blood and Marrow Transplantation/Center for International Blood and Marrow Transplant Research centers. A total of 96 patients underwent haploidentical allo-HCT between 2008 and 2016. With a median follow-up of 24.0 months (range, 13.2 to 24.9 months), 97% (95% confidence interval [CI], 93% to 100%) of patients had neutrophil engraftment by day 28, and 75% (95% CI, 66% to 84%) achieved platelet recovery by day 60. Two-year progression -free survival (PFS) was 17% (95% CI, 8% to 26%), and overall survival (OS) was 48% (95% CI, 36% to 59%). At 2 years, the cumulative risk of relapse/progression was 56% (95% CI, 45% to 67%), and 1-year nonrelapse mortality (NRM) was 21% (95% Cl, 13% to 29%). The incidences of acute graft-versus-host-disease (GVHD) grades ll-IV by 100 days and chronic GVHD at 2 years were 39% (95% CI, 28% to 49%) and 46% (95% CI, 34% to 59%), respectively. On univariate analysis, use of post-transplantation cyclophosphamide (PT-Cy) (54% [95% CI, 41% to 68%] versus 25% [95% CI, 1% to 48%]; P=.009) and use of bone marrow as source of stem cells (72% [95% CI, 55% to 89%] versus 31% [95% CI, 17% to 46%]; P=.001) were associated with improved OS at 2 years. Disease status, patient sex, intensity of conditioning regimen, recipient/donor sex mismatch, and cytomegalovirus serostatus had no impact on OS, PFS, or NRM. Haploidentical transplantation is feasible for patients with multiply relapsed or high-risk MM, with an encouraging 2-year OS of 48% and an NRM of 21% at 1 year, supporting further investigation of haploidentical allo-HCT in suitable candidates with MM. (C) 2018 American Society for Blood and Marrow Transplantation.
AB - Allogeneic hematopoietic cell transplantation (allo-HCT) using siblings and matched donors has the potential for long-term disease control in a subset of high-risk patients with multiple myeloma (MM); however, the data on using haploidentical donors in this disease are limited. We conducted a retrospective analysis to examine the outcomes of patients with MM who underwent haploidentical allo-HCT within European Society for Blood and Marrow Transplantation/Center for International Blood and Marrow Transplant Research centers. A total of 96 patients underwent haploidentical allo-HCT between 2008 and 2016. With a median follow-up of 24.0 months (range, 13.2 to 24.9 months), 97% (95% confidence interval [CI], 93% to 100%) of patients had neutrophil engraftment by day 28, and 75% (95% CI, 66% to 84%) achieved platelet recovery by day 60. Two-year progression -free survival (PFS) was 17% (95% CI, 8% to 26%), and overall survival (OS) was 48% (95% CI, 36% to 59%). At 2 years, the cumulative risk of relapse/progression was 56% (95% CI, 45% to 67%), and 1-year nonrelapse mortality (NRM) was 21% (95% Cl, 13% to 29%). The incidences of acute graft-versus-host-disease (GVHD) grades ll-IV by 100 days and chronic GVHD at 2 years were 39% (95% CI, 28% to 49%) and 46% (95% CI, 34% to 59%), respectively. On univariate analysis, use of post-transplantation cyclophosphamide (PT-Cy) (54% [95% CI, 41% to 68%] versus 25% [95% CI, 1% to 48%]; P=.009) and use of bone marrow as source of stem cells (72% [95% CI, 55% to 89%] versus 31% [95% CI, 17% to 46%]; P=.001) were associated with improved OS at 2 years. Disease status, patient sex, intensity of conditioning regimen, recipient/donor sex mismatch, and cytomegalovirus serostatus had no impact on OS, PFS, or NRM. Haploidentical transplantation is feasible for patients with multiply relapsed or high-risk MM, with an encouraging 2-year OS of 48% and an NRM of 21% at 1 year, supporting further investigation of haploidentical allo-HCT in suitable candidates with MM. (C) 2018 American Society for Blood and Marrow Transplantation.
KW - Multiple myeloma
KW - Haploidentical
KW - Allogeneic hematopoietic cell transplantation
KW - STEM-CELL TRANSPLANTATION
KW - TANDEM AUTOLOGOUS TRANSPLANTATION
KW - EUROPEAN-SOCIETY
KW - MARROW
KW - BLOOD
KW - DONOR
KW - LEUKEMIA
U2 - 10.1016/j.bbmt.2018.09.018
DO - 10.1016/j.bbmt.2018.09.018
M3 - Article
C2 - 30243581
SN - 1083-8791
VL - 25
SP - 335
EP - 342
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 2
ER -