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<p>Autologous hematopoietic cell transplantation (autoHCT) remains a therapeutic option for multiple myeloma (MM) at relapse. We retrospectively analyzed 650 patients who underwent delayed (<i>n</i> = 335) or salvage (<i>n</i> = 315) autoHCT at a single center from 2006–2023. Median age was 61.4 years; 22% were Black, and 21% had high-risk cytogenetics. Forty-nine percent received &gt;3 prior therapy lines, and 33% were lenalidomide-refractory. Non-relapse mortality was 3% at day 100 and 4% at 1 year. Median progression-free survival (mPFS) was 17.5 months and median overall survival (mOS) 47.3 months, with no significant difference between delayed and salvage autoHCT (mPFS 16.3 vs. 19.1 months; mOS 43.2 vs. 50.8 months). In salvage autoHCT, transplant ≥24 months after first autoHCT was associated with superior outcomes (mPFS 20.6 vs. 8.4 months; mOS 54.6 vs. 12.5 months; <i>p</i> &lt; 0.001). Multivariable analysis identified adverse factors for PFS and OS including high-risk cytogenetics, R-ISS stage II–III, lenalidomide- or carfilzomib-refractory disease, anti-CD38 antibody non-exposure, and &gt;3 prior therapy lines; achieving CR post-transplant and receiving maintenance predicted improved outcomes. This largest single-center cohort demonstrates delayed or salvage autoHCT is feasible and effective, particularly for patients with prolonged first remissions, and provides a benchmark for emerging therapies in relapsed/refractory MM.</p>

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Results of delayed or salvage autologous hematopoietic stem cell transplantation for multiple myeloma

  • 期刊论文

  • 发表日期：

    2025年12月5日

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  • Oren Pasvolsky,
  • Curtis Marcoux,
  • Denái R. Milton,
  • Asad A. Haider,
  • Mark R. Tanner,
  • Qaiser Bashir,
  • Samer Srour,
  • Neeraj Saini,
  • Portia Smallbone,
  • Paul Lin,
  • Jeremy Ramdial,
  • Yago Nieto,
  • Ali H. Mohamedi,
  • Umer R. Siddiqui,
  • Abdullah Jamil,
  • Guilin Tang,
  • Yosra Aljawai,
  • Hans C. Lee,
  • Krina K. Patel,
  • Partow Kebriaei,
  • Sheeba K. Thomas,
  • Robert Z. Orlowski,
  • Richard E. Champlin,
  • Elizabeth J. Shpall,
  • Muzaffar H. Qazilbash

摘要

Autologous hematopoietic cell transplantation (autoHCT) remains a therapeutic option for multiple myeloma (MM) at relapse. We retrospectively analyzed 650 patients who underwent delayed (n = 335) or salvage (n = 315) autoHCT at a single center from 2006–2023. Median age was 61.4 years; 22% were Black, and 21% had high-risk cytogenetics. Forty-nine percent received >3 prior therapy lines, and 33% were lenalidomide-refractory. Non-relapse mortality was 3% at day 100 and 4% at 1 year. Median progression-free survival (mPFS) was 17.5 months and median overall survival (mOS) 47.3 months, with no significant difference between delayed and salvage autoHCT (mPFS 16.3 vs. 19.1 months; mOS 43.2 vs. 50.8 months). In salvage autoHCT, transplant ≥24 months after first autoHCT was associated with superior outcomes (mPFS 20.6 vs. 8.4 months; mOS 54.6 vs. 12.5 months; p < 0.001). Multivariable analysis identified adverse factors for PFS and OS including high-risk cytogenetics, R-ISS stage II–III, lenalidomide- or carfilzomib-refractory disease, anti-CD38 antibody non-exposure, and >3 prior therapy lines; achieving CR post-transplant and receiving maintenance predicted improved outcomes. This largest single-center cohort demonstrates delayed or salvage autoHCT is feasible and effective, particularly for patients with prolonged first remissions, and provides a benchmark for emerging therapies in relapsed/refractory MM.