Second Autologous Stem Cell Transplant (ASCT) as Salvage Therapy for Relapsed Multiple Myeloma.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1170-1170
Author(s):  
Rebecca L. Olin ◽  
David L. Porter ◽  
Selina M. Luger ◽  
Stephen J. Schuster ◽  
Donald Tsai ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplant ◽  
Treatment Options ◽  
Univariate Analysis ◽  
Complete Response ◽  
Autologous Stem Cell Transplant ◽  
Response To Therapy ◽  
Cell Transplant ◽  
Significant Difference

Abstract Introduction: Autologous stem cell transplant (ASCT) as part of initial therapy has been shown to prolong survival of patients with multiple myeloma, with some achieving durable complete remission. However, the majority of patients ultimately relapse after ASCT and require salvage treatment. Options for the treatment of such patients have increased significantly over recent years, including not only novel chemotherapeutic and biological agents but also additional ASCTs. We performed a retrospective analysis of our experience with salvage ASCT for multiple myeloma to determine which clinical variables influence outcome. Methods: Between October 1992 and February 2005, we performed 342 ASCTs for multiple myeloma. Twenty-six of these were salvage transplants for relapsed disease after prior ASCT, and all were included in the analysis. Patients who received two planned (tandem) ASCTs were not included. Results: The median age at diagnosis was 47 (range 25–66), and median ISS and DS stages at diagnosis were 1 and 2, respectively. The initial ASCT was melphalan-based in 21/26; six (23%) achieved a complete response (CR) to the initial transplant, and fifteen (58%) achieved a partial response (PR). The median event-free survival (EFS) after the initial transplant was 19.5 months (range 2–60). The median time between initial and salvage ASCT was 2.6 years (range 0.3–7.6). Twenty-two patients (85%) received non-transplant therapy between ASCTs, and the median number of lines of therapy prior to salvage ASCT was 3. At the time of salvage ASCT, the median age was 52.5 (range 28–69). Fourteen patients received melphalan alone, eight received melphalan/TBI, and four received other regimens. Eleven patients (42%) achieved a response to therapy (1 CR, 10 PR). One patient (4%) died of transplant-related toxicity. The median follow-up after salvage ASCT is 12 months (range 0.2–58). Median EFS is 9 months, and median overall survival (OS) is 36 months. The 2-year EFS is 14%, and 2-year OS is 52%. On univariate analysis, both response to and EFS after initial transplant significantly predict improved EFS after salvage transplant (p=0.0008 and p=0.0065 respectively). Both also predict improved OS (p=0.03 and 0.0005 respectively). A greater than 12 month interval between first and second transplant also correlated with OS (p=0.04). There was no significant difference in EFS or OS by preparative regimen. Interestingly, type of response to the salvage transplant (CR/PR or less than PR) did not predict improved EFS or OS. Conclusion: This study suggests that salvage ASCT after relapse from initial ASCT is a feasible therapy for patients with heavily treated multiple myeloma, particularly those with a prolonged response to the first transplant.

scholarly journals Pericardial relapse of multiple myeloma

2020 ◽  
Vol 13 (4) ◽  
pp. e233340
Author(s):  
Lee S Jamison ◽  
Clifton Craig Mo ◽  
Mary Kwok
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Poor Prognosis ◽  
Stem Cell Transplant ◽  
Complete Response ◽  
Initial Therapy ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
Extramedullary Relapse ◽  
To Receive

In patients who experience relapse of multiple myeloma, upwards of 30% can have extramedullary disease. The presence of extramedullary multiple myeloma is typically associated with adverse cytogenetics and a poor prognosis. Organs most commonly involved include the liver, skin, central nervous system, pleural effusions, kidney, lymph nodes, and pancreas. We present the case of a 53-year-old man with IgA kappa multiple myeloma with the adverse cytogenetic findings of t(4;14) and 1q21 gain who had achieved a stringent complete (sCR) response after initial therapy with carfilzomib, lenalidomide and dexamethasone. Stringent complete response is defined as the normalization of the free light chain ratio in the serum and an absence of clonal cells in the bone marrow in additiion to criteria needed to achieve complete response. Prior to undergoing a planned autologous stem cell transplant, this patient experienced cardiac tamponade secondary to extramedullary relapse of his multiple myeloma which was limited to the pericardium. In response, his treatment regimen was transitioned to pomalidomide, bortezomib, dexamethasone and cyclophosphamide for three cycles after which he again achieved sCR and ultimately underwent autologous stem cell transplant. Post-transplant consolidation therapy was administered in the form of pomalidomide, bortezomib and dexamethasone, followed by pomalidomide and bortezomib maintenance, which he has continued to receive for 3 years without evidence of disease progression.

scholarly journals Complete response after autologous stem cell transplant in multiple myeloma

2014 ◽  
Vol 3 (4) ◽  
pp. 939-946 ◽  
Author(s):  
Lalit Kumar ◽  
Nida Iqbal ◽  
Anjali Mookerjee ◽  
Rakesh Kumar Verma ◽  
Om D. Sharma ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplant ◽  
Complete Response ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant

Rezidivtherapie des Multiplen Myeloms – Individualisierte Konzepte aus dem Arsenal vielfältiger Optionen

2020 ◽  
Vol 145 (12) ◽  
pp. 820-827
Author(s):  
Charlotte Weyermann ◽  
Christian Straka ◽  
Hermann Einsele
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
High Risk ◽  
Stem Cell Transplant ◽  
Treatment Options ◽  
Autologous Stem Cell Transplant ◽  
Patient Specific ◽  
Cell Transplant ◽  
Allogenic Stem Cell Transplant ◽  
The Individual

AbstractThe prognosis of patients with multiple myeloma has improved significantly over the past 20 years. However, the patient population in the relapse situation is very heterogeneous due to increasing age and the previous course of the disease and therapy. In particular, the approval of new targeted substances offers numerous treatment options that can be adapted to the individual situation.In relapsed multiple myeloma, disease- and patient-specific factors must be considered for an individually adapted therapy. Suitable patients can also receive an autologous stem cell transplant (ASCT) or, in the case of early relapse after ASCT, an allogenic stem cell transplant, if possible as part clinical studies. Proteasome or immunomodulator-based triple combinations are the standard in recurrence. In frail patients, a combination of two can also be used. The new substances also offer very good therapeutic options for high-risk cytogenetics or renal insufficiency. The monoclonal antibodies Daratumumab and Elotuzumab are well tolerated except for infusion reactions and are highly effective in various combinations, even in high-risk cytogenetics.

A Phase 1 Study of Bendamustine and Melphalan Conditioning for Autologous Stem Cell Transplant in Multiple Myeloma

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2042-2042
Author(s):  
Tomer M Mark ◽  
Whitney Reid ◽  
Ruben Niesvizky ◽  
Usama Gergis ◽  
Roger N Pearse ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Partial Response ◽  
Stem Cell Transplant ◽  
Phase 1 ◽  
Complete Response ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
Phase 1 Study ◽  
Dose Levels

Abstract Abstract 2042 Background: Given data showing efficacy of bendamustine in treating multiple myeloma (MM), with the known toxicity profile significant for myelosuppression, we hypothesized that the addition of bendamustine to autologous stem cell transplant (ASCT) conditioning would enhance response without significant toxicity change. We now report the results of a phase 1 study of bendamustine + melphalan conditioning ASCT in MM. Methods: 21 patients were enrolled onto a 3+3 phase 1 study of bendamustine added to melphalan 200mg/m2 split on subsequent days at the following dose levels on the indicated days of melphalan: 1) 30 mg/m2 given on day 2; 2) 60 mg/m2 on day 2; 3) 90 mg/m2 on day 2; 4) 60mg/m2 on days 1 and 2; 5) 90 mg/m2 on day 1 and 60mg/m2 on day 2; 6) 125 mg/m2 on day 1 and 100mg/m2 on day 2. Stem cell infusion of > 2 million × 106 CD34+ cells/kg was performed at 24–48 hours after final chemotherapy. Patients received G-CSF with standard supportive care until engraftment, defined as absolute neutrophil count > 500/ml and a platelet count > 20,000/ml. Bone marrow biopsy and skeletal imaging were prior to and 100 days after ASCT to assess baseline and post-ASCT disease status. Disease response evaluation was performed monthly with immunoelectrophoresis and free light chain analysis in accordance with international uniform myeloma reporting criteria. Results: Twenty-one patients completed ASCT over 6 cohorts: 3 in dose level 1, 6 at dose level 2, and 3 each in dose levels 3, 4, 5, and 6. Median number of days (range) to wbc engraftment and platelet engraftment was 11 (9–13) and 12.5 (10–22), respectively. Toxicities were graded according to the Bearman scale. There was only one Grade 3 toxicity: a patient with respiratory decompensation in the setting of neutropenic fever in cohort 2 (a pulmonary dose limiting toxicity-DLT). Other toxicities noted in patients (%) (Grade 1 / Grade 2 respectively) were Cardiac: 6 (29%) / 2 (10%); Pulmonary 1 (5%) / 1 (5%); CNS 0 / 1 (5%); Stomatitis 15 (71%) / 0; GI 10 (48%) / 1 (5%). The CNS toxicity was narcotic-related psychosis. Eight patients had neutropenic fever, with 3 cases of bacteremia. No transplant-related mortality occurred. At present, there are 18 evaluable Day +100 myeloma responses: disease progression in 5 (24%), stable disease in 1 (6%), partial response 1 (6%), very good partial response in 2 (11%), and complete response in 9 (50%). Four patients (19%) died from MM, all with disease progression at 100 days post-ASCT, and all with pre-existing extramedullary disease. Summary: Bendamustine added to ASCT conditioning in MM does not exacerbate expected toxicities. The maximum tolerated dose of bendamustine in combination with melphalan 200mg/m2 was not found after a series of 6 treatment cohorts. The relatively high complete response rate and good regimen tolerability has prompted an extension phase 2 trial at the cohort 6 dosing to further evaluate regimen efficacy. Disclosures: Off Label Use: The study evaluates bendamustine safety in transplantation for myeloma; there is no FDA-label for this. Niesvizky:Merck: Research Funding.

Effect of lenalidomide use as part of induction chemotherapy on the risk of peri-transplant venous thromboembolic events (VTE) in patients undergoing autologous stem cell transplant for multiple myeloma.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e19524-e19524
Author(s):  
Naresh Bumma ◽  
Monica Peravali ◽  
Ghayathri Jeyakumar ◽  
Seongho Kim ◽  
Asif Alavi ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplant ◽  
Retrospective Chart Review ◽  
Autologous Stem Cell Transplant ◽  
Induction Treatment ◽  
Cell Transplant ◽  
Vte Prophylaxis ◽  
Significant Difference ◽  
Venous Thromboembolic Events

e19524 Background: Lenalidomide (len) is approved for treatment in Multiple Myeloma (MM) Use of len has been associated with an increase in venous thrombotic events (VTE) and aspirin prophylaxis is recommended for pts who are on active treatment with len. Autologous stem cell transplant (ASCT) is used during the treatmentof MM after initial induction therapy. The use of intravenous catheters and hospitalization increase the risk of VTE in peri-transplant period. We evaluated the incidence of VTE in peri-transplant period to determine if len use increased the risk of VTE. Methods: We performed a retrospective chart review of pts with MM who underwent first ASCT at our institution between 1/2011-1/2015.Data was collected on pt. demographics, len use, VTE prophylaxis, VTE incidence and VTE treatment. Chemical anticoagulation during the peri-transplant period was based on physician preference and chemical anticoagulation was stopped once platelet counts dropped below 50,000/ uL. All pts were encouraged to ambulate daily for mechanical prophylaxis. Associations with incidence of VTE were conducted by univariable and multivariable logistic regression analyses. Results: A total of 303 pts met the study criteria. 204 pts received Len as part of induction treatment while 99 did not. There was no significant difference in demographics of the 2 groups. 87% pts in the Len group and 81% in the non-Len group did not receive any chemical prophylaxis, respectively during hospitalization. 15 pts developed DVT within 100 days of transplant: 10 in len group and 5 in non-len group (p > 0.99). 14 of the 15 were catheter associated. Median time to DVT was 10.5 days post-transplant. Caucasians had a higher risk of DVT; adjusted OR 0.315 (95%CI 0.03-0.99; p = 0.046). Incidence of VTE was not affected by prophylaxis, or response to induction. Conclusions: Despite the fact that during the peri-transplant period most of the patients were not on prophylactic chemical anticoagulation due to chemotherapy associated thrombocytopenia len use during the induction treatment did not increase the risk of peri-transplant VTE.

The Hematopoietic Stem Cell Transplant Comorbidity Index (HCT-CI) Can Predict for Readmission Following Autologous Stem Cell Transplant for Lymphoma and Multiple Myeloma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4286-4286
Author(s):  
Samantha M. Jaglowski ◽  
Craig C. Hofmeister ◽  
Patrick Elder ◽  
Sam Penza ◽  
Yvonne A Efebera ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplant ◽  
Cell Lymphoma ◽  
Univariate Analysis ◽  
Autologous Stem Cell Transplant ◽  
Early Mortality ◽  
Hodgkin's Lymphoma ◽  
Cell Transplant ◽  
Comorbidity Index

Abstract Abstract 4286 Introduction: Patients (pts) who undergo autologous stem cell transplant (ASCT) for lymphoma and multiple myeloma (MM) are often older and frequently have multiple comorbidities, as well as diminished performance status (PS). The presence of comorbidities has been shown to influence overall survival (OS) following ASCT for non-Hodgkin's lymphoma, but not for MM, and comorbidity indices can predict readmission in multiple settings. The hematopoietic cell transplantation-specific comorbidity index (HCT-CI) can predict risk of readmission following allo-SCT, but this has not been evaluated for ASCT. Methods: We conducted an analysis of 688 consecutive pts who received ASCT at the Ohio State University from 2000–2010 for lymphoma or MM in order to identify pre-transplant factors associated with readmission and early mortality. Univariate and multivariate logistic regression were used to predict the odds of readmission within the first 100 days following ASCT or the odds of death within the first 100 days. Cox regression was used to evaluate OS. Results: 408 (59%) of pts were male, 46 (7%) were age ≥70, 367 (53%) had MM and 322 (47%) had lymphoma (110 Hodgkin's lymphoma, 125 diffuse large B cell lymphoma (DLBCL), 17 follicular lymphoma, 51 mantle cell lymphoma, 17 peripheral T cell lymphoma, 2 gray zone). The most common conditioning regimens were melphalan (327), BEAM (167), and BuCyVP (110). Sixty five percent had a Karnofsky PS (KPS) of ≥90. HCT-CI score was available in 431 patients and was 0 in 99 (23%), 1–2 in 169 (39%), and ≥3 in 163 (38%). 14% were readmitted within 100 days of transplant, and 4% died within the first 100 days. On univariate analysis, increased odds of readmission were significantly associated with conditioning with BuCyVP relative to melphalan, KPS≤80, and HCT-CI≥3 (Table 1). In transplants after 2006 when HCT-CI was incorporated as standard of care, HCT-CI≥3 remained statistically significant for readmission (OR 2.54, 95% CI 1.15–5.56). Mortality within 100 days was associated with readmission, gender, DLBCL vs MM, KPS≤80, and use of plerixafor for mobilization on univariate analysis. Early mortality was significantly associated with female sex (OR 0.16, 95% CI 0.03–0.66) and readmission within 100 days (OR 3.90, 95% CI 1.3–11.6) on multivariate analysis. After excluding patients who died within the first 30 days and who relapsed within the first 100 days, readmission within 100 days of transplant (HR 1.75, 95% CI 1.21–2.56, p=0.003) (Figure 1), and KPS≤80 (HR 1.41, 95% CI 1.05–1.87, p=0.02) are associated with inferior OS, but HCT-CI was not. Conclusion: While an HCT-CI score ≥3 was associated with readmission, it was not associated with early mortality or OS in pts with MM or lymphoma. Readmission within 100 days and KPS≤80 were significantly associated with inferior OS, and readmission was significantly associated with early mortality. Evaluation of other assessment tools, including frailty assessments, may identify patients who could benefit from earlier rehabilitative interventions, either prior to or following ASCT. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Patient‐reported outcomes following autologous stem cell transplant for patients with multiple myeloma

eJHaem ◽  
2021 ◽  
Author(s):  
Noa Biran ◽  
Wanting Zhai ◽  
Roxanne E. Jensen ◽  
Jeanne Mandelblatt ◽  
Susan Kumka ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Patient Reported Outcomes ◽  
Stem Cell Transplant ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
Patient Reported
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