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Singh S, Sharma R, Singh J, Jain K, Paul D. Autologous stem cell transplantation for multiple myeloma in the novel agent era: Systematic review of Indian data and implications for resource constrained settings. J Cancer Res Ther 2022; 19:S12-S19. [PMID: 37147978 DOI: 10.4103/jcrt.jcrt_503_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Treatment of multiple myeloma has undergone significant advances in the last two decades, leading to meaningful improvement in overall and progression free survival. The incurable nature of disease necessitates serial sequencing of treatment options and continuous therapy once disease remission is achieved. Autologous stem cell transplantation (ASCT) has continued to offer a meaningful survival advantage with a consistent reduction in toxicity and costs. Despite the advent of newer drugs leading to deeper and sustained responses, ASCT continues to be the standard of care for all eligible patients and is ostensibly more cost effective than continued treatment with newer agents. However, ASCT continues to be underutilized in India, due to concerns about cost, safety, and sporadic expertize. We present a systematic review of available data on ASCT for multiple myeloma from India to evaluate safety and efficacy of the procedure, and provide evidence re-affirming its utility in resource constrained settings.
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Pasvolsky O, Yeshurun M, Fraser R, Estrada-Merly N, Rozovski U, Shargian L, Assal A, Banerjee R, Bumma N, Gale RP, Hagen P, Holmberg L, Hossain NM, Lazarus HM, Lee C, Mian H, Miller KC, Nathan S, Nagler A, Nishihori T, Parrondo RD, Patel S, Schroeder MA, Usmani SZ, Wang T, Wirk B, Kumar S, Shah N, Qazilbash MH, D’Souza A. Maintenance therapy after second autologous hematopoietic cell transplantation for multiple myeloma. A CIBMTR analysis. Bone Marrow Transplant 2022; 57:31-37. [PMID: 34608275 PMCID: PMC8764606 DOI: 10.1038/s41409-021-01455-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 02/08/2023]
Abstract
The role of maintenance therapy after high-dose chemotherapy and first autologous transplantation in multiple myeloma (MM) is well established. We explored the effect of maintenance therapy on outcomes after salvage second autologous hematopoietic cell transplant (AHCT2) using the Center for International Blood and Marrow Transplant Research registry. Outcomes of interest included non-relapse mortality (NRM), relapse/progression (REL), progression-free and overall survival (PFS, OS). Of 522 patients who underwent AHCT2 between 2010 and 2018, 342 received maintenance therapy and 180 did not. Maintenance regimens included lenalidomide (42%), pomalidomide (13%), and bortezomib (13%). Median follow up was 58 months in the maintenance group and 61.5 months in the no-maintenance group. Univariate analysis showed superior outcomes at 5 years in maintenance compared to the no-maintenance group: NRM 2 (0.7-3.9)% vs 9.9 (5.9-14.9)%, (p < 0.01), REL 70.2 (64.4-75.8)% vs 80.3 (73.6-86.3)% (p < 0.01), PFS 27.8 (22.4-33.5)% vs. 9.8 (5.5-15.2)% (p < 0.01), and OS 54 (47.5-60.5)% vs 30.9 (23.2-39.2)% (p < 0.01), respectively. Use of maintenance therapy retained its association with improved outcomes in multivariate analysis. There was no difference in second cancers in the two groups (p = 0.39). We conclude that maintenance after AHCT2 is associated with improved 5-year outcomes.
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Affiliation(s)
- Oren Pasvolsky
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikvah, Israel;,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Yeshurun
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikvah, Israel;,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raphael Fraser
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI;,Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Noel Estrada-Merly
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Uri Rozovski
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikvah, Israel
| | - Liat Shargian
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikvah, Israel
| | - Amer Assal
- Columbia University Irving Medical Center, Department of Medicine, Bone Marrow Transplant and Cell Therapy Program, New York, NY
| | - Rahul Banerjee
- Division of Hematology-Oncology, University of California San Francisco, San Francisco, CA
| | - Naresh Bumma
- Ohio State Medical Center, James Cancer Center, Columbus , OH
| | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK
| | | | | | - Nasheed M. Hossain
- Department of Medicine, Division of Hematology/Oncology, Stem Cell Transplant Program – Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - Hillard M. Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Cindy Lee
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Hira Mian
- McMaster University, Hamilton, ON, Canada
| | | | - Sunita Nathan
- Section of Bone Marrow Transplant and Cell Therapy, Rush University Medical Center, Chicago, IL
| | - Arnon Nagler
- Hematology Division and BMT, Chaim Sheba Medical Center, Tel Hashomer, Israel;,Tel Aviv University, Tel Aviv, Israel
| | - Taiga Nishihori
- Department of Blood & Marrow Transplant and Cellular Immunotherapy (BMT CI), Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Ricardo D Parrondo
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonsville, FL
| | - Sagar Patel
- Blood and Marrow Transplant Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Mark A. Schroeder
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Saad Z. Usmani
- Department of Hematologic Oncology & Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, NC
| | - Trent Wang
- Division of Transplantation and Cellular Therapy, University of Miami, Miami, FL
| | - Baldeep Wirk
- Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, PA
| | | | - Nina Shah
- Division of Hematology-Oncology, University of California San Francisco, San Francisco, CA
| | | | - Anita D’Souza
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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Mohyuddin GR, Okoniewski M, Diab O, Ganguly S, Shune L, Abdallah AO, McGuirk J, McClune B. Maintenance regimens after a second autologous transplant for multiple myeloma. Leuk Lymphoma 2020; 62:758-760. [PMID: 33146051 DOI: 10.1080/10428194.2020.1842402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Maire Okoniewski
- Department of Internal Medicine, University of Kansas, Kansas City, KS, USA
| | - Osama Diab
- Division of Hematology Oncology, University of Kansas, Kansas City, KS, USA
| | - Siddhartha Ganguly
- Department of Hematological Malignancies and Cellular Therapeutics, University of Kansas, Kansas City, KS, USA
| | - Leyla Shune
- Department of Hematological Malignancies and Cellular Therapeutics, University of Kansas, Kansas City, KS, USA
| | - Al-Ola Abdallah
- Department of Hematological Malignancies and Cellular Therapeutics, University of Kansas, Kansas City, KS, USA
| | - Joseph McGuirk
- Department of Hematological Malignancies and Cellular Therapeutics, University of Kansas, Kansas City, KS, USA
| | - Brian McClune
- Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
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