Upfront stem cell transplantation for newly diagnosed multiple myeloma with del(17p) and t(4;14): a study from the CMWP-EBMT
: Nico Gagelmann, Diderik-Jan Eikema, Liesbeth C. de Wreede, Alessandro Rambaldi, Simona Iacobelli, Linda Koster, Denis Caillot, Didier Blaise, Péter Remémyi, Claude-Eric Bulabois, Jakob Passweg, Xavier Leleu, Samo Zver, Guido Kobbe, Per Ljungman, Patrice Chevallier, Mark Ringhoffer, Murray Martin, Urpu Salmenniemi, Xavier Poiré, Stig Lenhoff, Pietro Pioltelli, Nicola Mordini, Michel Delforge, Laurent Garderet, Stefan Schönland, Ibrahim Yakoub-Agha, Nicolaus Kröger
Publisher: NATURE PUBLISHING GROUP
: 2020
: Bone Marrow Transplantation
: BONE MARROW TRANSPLANTATION
: BONE MARROW TRANSPL
: 56
: 210
: 217
: 8
: 0268-3369
: 1476-5365
DOI: https://doi.org/10.1038/s41409-020-01007-w
We analyzed newly diagnosed multiple myeloma patients with del(17p) and/or t(4;14) undergoing either upfront single autologous (auto), tandem autologous (auto-auto) or tandem autologous/reduced-intensity allogeneic (auto-allo) stem cell transplantation. 623 patients underwent either auto (n = 446), auto-auto (n = 105), or auto-allo (n = 72) between 2000 and 2015. 46% of patients had t(4;14), 45% had del(17p) while 9% were reported having both abnormalities. Five-year overall survival (OS) was 51% (95% confidence interval [CI], 45-58%) for single auto, 60% (95% CI, 49-72%) for auto-auto, and 67% (95% CI, 53-80%) for auto-allo (p = 0.187). Five-year progression-free survival (PFS) was 17% (95% CI, 12-22%), 33% (95% CI, 22-43%), and 34% (95% CI, 21-38%;p = 0.048). Five-year relapse rate was 82, 63, and 56%, while non-relapse mortality was 1, 4, and 10%. In multivariable analysis, in t(4;14) with single auto as reference, auto-auto (hazard ratio [HR], 0.44;p = 0.007) and auto-allo (HR, 0.45;p = 0.018) were associated with better PFS. In terms of t(4;14) and OS, auto-auto appeared to improve outcome compared with single auto (HR, 0.49;p = 0.096). In del(17p), outcome in PFS was similar between single auto and auto-auto, while auto-allo appeared to improve PFS (HR, 0.65;p = 0.097). No significant difference in OS was identified between the groups in patients with del(17p).
