Prognostic Factors for Postrelapse Survival after ex Vivo CD34+-Selected (T Cell-Depleted) Allogeneic Hematopoietic Cell Transplantation in Multiple Myeloma

Alexandra Gomez-Arteaga, Gunjan L. Shah, Raymond E. Baser, Michael Scordo, Josel D. Ruiz, Adam Bryant, Parastoo B. Dahi, Arnab Ghosh, Oscar B. Lahoud, Heather J. Landau, Ola Landgren, Brian C. Shaffer, Eric L. Smith, Guenther Koehne, Miguel Angel Perales, Sergio A. Giralt, David J. Chung

Research output: Contribution to journalArticlepeer-review

Abstract

Allogeneic hematopoietic cell transplantation (alloHCT) for multiple myeloma (MM), with its underlying graft-versus-tumor capacity, is a potentially curative approach for high-risk patients. Relapse is the main cause of treatment failure, but predictors for postrelapse survival are not well characterized. We conducted a retrospective analysis to evaluate predictors for postrelapse overall survival (OS) in 60 MM patients who progressed after myeloablative T cell-depleted alloHCT. The median patient age was 56 years, and 82% had high-risk cytogenetics. Patients received a median of 4 lines of therapy pre-HCT, and 88% achieved at least a partial response (PR) before alloHCT. Of the 38% who received preemptive post-HCT therapy, 13 received donor lymphocyte infusions (DLIs) and 10 received other interventions. Relapse was defined as very early (<6 months; 28%), early (6 to 24 months; 50%), or late (>24 months; 22%). At relapse, 27% presented with extramedullary disease (EMD). The median postrelapse overall survival (OS) by time to relapse was 4 months for the very early relapse group, 17 months for the early relapse group, and 72 months for the late relapse group (P = .002). Older age, relapse with EMD, <PR before alloHCT, <PR by day +100, and no maintenance were prognostic for inferior postrelapse OS on univariate analysis. On multivariate analysis adjusted for age and sex, very early relapse (hazard ratio [HR], 4.37; 95% confidence interval [CI], 1.42 to 13.5), relapse with EMD (HR, 5.20; 95% CI, 2.10 to 12.9), and DLI for relapse prevention (HR, .11; 95% CI, 2.10 to 12.9) were significant predictors for postrelapse survival. Despite their shared inherent high-risk status, patients with MM have significantly disparate post-HCT relapse courses, with some demonstrating long-term survival despite relapse.

Original languageEnglish (US)
Pages (from-to)2040-2046
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume26
Issue number11
DOIs
StatePublished - Nov 2020
Externally publishedYes

Keywords

  • Allogeneic hematopoietic stem cell transplantation
  • CD34 selection
  • Donor lymphocyte infusion
  • Multiple myeloma
  • Relapse
  • T cell depletion

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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