Transplantation as salvage therapy for high-risk patients with myeloma in relapse

C. K. Lee, B. Barlogie, M. Zangari, A. Fassas, E. Anaissie, C. Morris, F. van Rhee, M. Cottler-Fox, R. Thertulien, F. Muwalla, S. Mazher, A. Badros, G. Tricot

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Patients with myeloma relapsing after tandem transplant have a poor survival and treatment options are limited. The role of additional salvage transplant procedures for these patients is unknown. To evaluate the benefit and identify prognostic factors, the outcome of 76 consecutive patients with recurrent myeloma after tandem transplant receiving salvage transplants (ST) was analyzed. Prior to ST, 23 patients (30%) had shown chemosensitive response to preceding salvage chemotherapy: two complete remissions (CR); eight near CRs (nCR: only immunofixation positive); 13 partial remissions (PR ≥75% reduction in M protein). Fifty received an autologous transplant, 22 a sibling-matched allogeneic transplant, and four a matched-unrelated allogeneic transplant. Overall response after ST was 59%: eight CRs (11%); 14 nCRs (18%); 23 PRs (30%). Overall survival (OS) at 2 years was 19%; 2 year event-free survival rate (EFS) 7%. On univariate analysis for survival, only pre-transplant chemosensitive relapse (P < 0.05), serum albumin >3 g/dl (P = 0.001), normal LDH (P = 0.04), and long interval between the second transplant and relapse/progression were significant beneficial factors. In a Cox proportional hazard model, chemosensitive relapse, and albumin >3 g/dl were significant for better OS: hazard ratio (HR) 1.4, 1.7, respectively, while normal LDH, and absence of CA13 were significant for better EFS: HR 1.8, 1.7, respectively. Patients with albumin >3 g/dl who had chemosensitive disease before ST (n = 16) had a median survival of 16 months, compared to 7 months (n = 34) and 2 months (n = 26) for patients with only one (n = 34) or no favorable prognostic factors (n = 28), respectively (P < 0.001). Their survival at 2 years post-ST was 43%, 17% and 11%, respectively. Our study suggests further transplantation should only be considered in the setting of a clinical trial in patients with favorable prognostic factors.

Original languageEnglish (US)
Pages (from-to)873-878
Number of pages6
JournalBone Marrow Transplantation
Volume30
Issue number12
DOIs
StatePublished - Dec 1 2002
Externally publishedYes

Fingerprint

Salvage Therapy
Transplantation
Transplants
Recurrence
Survival
Disease-Free Survival
Albumins
Survival Rate
Autografts
Survival Analysis
Proportional Hazards Models
Siblings

Keywords

  • Refractory myeloma
  • Salvage transplantation

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Lee, C. K., Barlogie, B., Zangari, M., Fassas, A., Anaissie, E., Morris, C., ... Tricot, G. (2002). Transplantation as salvage therapy for high-risk patients with myeloma in relapse. Bone Marrow Transplantation, 30(12), 873-878. https://doi.org/10.1038/sj.bmt.1703715

Transplantation as salvage therapy for high-risk patients with myeloma in relapse. / Lee, C. K.; Barlogie, B.; Zangari, M.; Fassas, A.; Anaissie, E.; Morris, C.; van Rhee, F.; Cottler-Fox, M.; Thertulien, R.; Muwalla, F.; Mazher, S.; Badros, A.; Tricot, G.

In: Bone Marrow Transplantation, Vol. 30, No. 12, 01.12.2002, p. 873-878.

Research output: Contribution to journalArticle

Lee, CK, Barlogie, B, Zangari, M, Fassas, A, Anaissie, E, Morris, C, van Rhee, F, Cottler-Fox, M, Thertulien, R, Muwalla, F, Mazher, S, Badros, A & Tricot, G 2002, 'Transplantation as salvage therapy for high-risk patients with myeloma in relapse', Bone Marrow Transplantation, vol. 30, no. 12, pp. 873-878. https://doi.org/10.1038/sj.bmt.1703715
Lee CK, Barlogie B, Zangari M, Fassas A, Anaissie E, Morris C et al. Transplantation as salvage therapy for high-risk patients with myeloma in relapse. Bone Marrow Transplantation. 2002 Dec 1;30(12):873-878. https://doi.org/10.1038/sj.bmt.1703715
Lee, C. K. ; Barlogie, B. ; Zangari, M. ; Fassas, A. ; Anaissie, E. ; Morris, C. ; van Rhee, F. ; Cottler-Fox, M. ; Thertulien, R. ; Muwalla, F. ; Mazher, S. ; Badros, A. ; Tricot, G. / Transplantation as salvage therapy for high-risk patients with myeloma in relapse. In: Bone Marrow Transplantation. 2002 ; Vol. 30, No. 12. pp. 873-878.
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abstract = "Patients with myeloma relapsing after tandem transplant have a poor survival and treatment options are limited. The role of additional salvage transplant procedures for these patients is unknown. To evaluate the benefit and identify prognostic factors, the outcome of 76 consecutive patients with recurrent myeloma after tandem transplant receiving salvage transplants (ST) was analyzed. Prior to ST, 23 patients (30{\%}) had shown chemosensitive response to preceding salvage chemotherapy: two complete remissions (CR); eight near CRs (nCR: only immunofixation positive); 13 partial remissions (PR ≥75{\%} reduction in M protein). Fifty received an autologous transplant, 22 a sibling-matched allogeneic transplant, and four a matched-unrelated allogeneic transplant. Overall response after ST was 59{\%}: eight CRs (11{\%}); 14 nCRs (18{\%}); 23 PRs (30{\%}). Overall survival (OS) at 2 years was 19{\%}; 2 year event-free survival rate (EFS) 7{\%}. On univariate analysis for survival, only pre-transplant chemosensitive relapse (P < 0.05), serum albumin >3 g/dl (P = 0.001), normal LDH (P = 0.04), and long interval between the second transplant and relapse/progression were significant beneficial factors. In a Cox proportional hazard model, chemosensitive relapse, and albumin >3 g/dl were significant for better OS: hazard ratio (HR) 1.4, 1.7, respectively, while normal LDH, and absence of CA13 were significant for better EFS: HR 1.8, 1.7, respectively. Patients with albumin >3 g/dl who had chemosensitive disease before ST (n = 16) had a median survival of 16 months, compared to 7 months (n = 34) and 2 months (n = 26) for patients with only one (n = 34) or no favorable prognostic factors (n = 28), respectively (P < 0.001). Their survival at 2 years post-ST was 43{\%}, 17{\%} and 11{\%}, respectively. Our study suggests further transplantation should only be considered in the setting of a clinical trial in patients with favorable prognostic factors.",
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AU - Morris, C.

AU - van Rhee, F.

AU - Cottler-Fox, M.

AU - Thertulien, R.

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N2 - Patients with myeloma relapsing after tandem transplant have a poor survival and treatment options are limited. The role of additional salvage transplant procedures for these patients is unknown. To evaluate the benefit and identify prognostic factors, the outcome of 76 consecutive patients with recurrent myeloma after tandem transplant receiving salvage transplants (ST) was analyzed. Prior to ST, 23 patients (30%) had shown chemosensitive response to preceding salvage chemotherapy: two complete remissions (CR); eight near CRs (nCR: only immunofixation positive); 13 partial remissions (PR ≥75% reduction in M protein). Fifty received an autologous transplant, 22 a sibling-matched allogeneic transplant, and four a matched-unrelated allogeneic transplant. Overall response after ST was 59%: eight CRs (11%); 14 nCRs (18%); 23 PRs (30%). Overall survival (OS) at 2 years was 19%; 2 year event-free survival rate (EFS) 7%. On univariate analysis for survival, only pre-transplant chemosensitive relapse (P < 0.05), serum albumin >3 g/dl (P = 0.001), normal LDH (P = 0.04), and long interval between the second transplant and relapse/progression were significant beneficial factors. In a Cox proportional hazard model, chemosensitive relapse, and albumin >3 g/dl were significant for better OS: hazard ratio (HR) 1.4, 1.7, respectively, while normal LDH, and absence of CA13 were significant for better EFS: HR 1.8, 1.7, respectively. Patients with albumin >3 g/dl who had chemosensitive disease before ST (n = 16) had a median survival of 16 months, compared to 7 months (n = 34) and 2 months (n = 26) for patients with only one (n = 34) or no favorable prognostic factors (n = 28), respectively (P < 0.001). Their survival at 2 years post-ST was 43%, 17% and 11%, respectively. Our study suggests further transplantation should only be considered in the setting of a clinical trial in patients with favorable prognostic factors.

AB - Patients with myeloma relapsing after tandem transplant have a poor survival and treatment options are limited. The role of additional salvage transplant procedures for these patients is unknown. To evaluate the benefit and identify prognostic factors, the outcome of 76 consecutive patients with recurrent myeloma after tandem transplant receiving salvage transplants (ST) was analyzed. Prior to ST, 23 patients (30%) had shown chemosensitive response to preceding salvage chemotherapy: two complete remissions (CR); eight near CRs (nCR: only immunofixation positive); 13 partial remissions (PR ≥75% reduction in M protein). Fifty received an autologous transplant, 22 a sibling-matched allogeneic transplant, and four a matched-unrelated allogeneic transplant. Overall response after ST was 59%: eight CRs (11%); 14 nCRs (18%); 23 PRs (30%). Overall survival (OS) at 2 years was 19%; 2 year event-free survival rate (EFS) 7%. On univariate analysis for survival, only pre-transplant chemosensitive relapse (P < 0.05), serum albumin >3 g/dl (P = 0.001), normal LDH (P = 0.04), and long interval between the second transplant and relapse/progression were significant beneficial factors. In a Cox proportional hazard model, chemosensitive relapse, and albumin >3 g/dl were significant for better OS: hazard ratio (HR) 1.4, 1.7, respectively, while normal LDH, and absence of CA13 were significant for better EFS: HR 1.8, 1.7, respectively. Patients with albumin >3 g/dl who had chemosensitive disease before ST (n = 16) had a median survival of 16 months, compared to 7 months (n = 34) and 2 months (n = 26) for patients with only one (n = 34) or no favorable prognostic factors (n = 28), respectively (P < 0.001). Their survival at 2 years post-ST was 43%, 17% and 11%, respectively. Our study suggests further transplantation should only be considered in the setting of a clinical trial in patients with favorable prognostic factors.

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