Abstract
High-dose therapy and auto-SCT remain integral in the initial treatment of multiple myeloma (MM), and are increasingly being applied for management of relapsed disease. We examined the outcomes in 98 patients undergoing salvage auto-SCT (auto-SCT2) for relapsed MM after receiving an initial transplant (auto-SCT1) between 1994 and 2009. The median age at auto-SCT2 was 60 years (range: 35–74). The median time between auto-SCT1 and auto-SCT2 was 46 months (range: 10–130). Treatment-related mortality was seen in 4%. The median PFS from auto-SCT2 was 10.3 (95% confidence interval (CI): 7–14) months and the median OS from auto-SCT2 was 33 months (95% CI: 28–51). In a multivariable analysis, shorter time to progression (TTP) after auto-SCT1, not achieving a CR after auto-SCT2, higher number of treatment regimens before auto-SCT2 and a higher plasma cell labeling index at auto-SCT2 predicted for shorter PFS. However, only a shorter TTP after auto-SCT1 predicted for a shorter OS post auto-SCT2. Hence, auto-SCT2 is an effective and feasible therapeutic option for MM patients relapsing after other treatments, especially in patients who had a TTP of at least 12 months after their auto-SCT1.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Cancer Facts and Figures 2012. American Cancer Society: Atlanta, GA, 2012.
Mehta J, Singhal S . High-dose chemotherapy and autologous stem cell transplantation in myeloma patients under the age of 65 years. Bone Marrow Transplant 2007; 40: 1101–1114.
Attal M, Harousseau JL, Stoppa AM, Sotto JJ, Fuzibet JG, Rossi JF et al. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Francais du Myelome. N Engl J Med 1996; 335: 91–97.
Child JA, Morgan GJ, Davies FE, Owen RG, Bell SE, Hawkins K et al. High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med 2003; 348: 1875–1883.
Dimopoulos M, Spencer A, Attal M, Prince HM, Harousseau JL, Dmoszynska A et al. Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma. N Engl J Med 2007; 357: 2123–2132.
Richardson PG, Sonneveld P, Schuster MW, Irwin D, Stadtmauer EA, Facon T et al. Bortezomib or high-dose dexamethasone for relapsed multiple myeloma. N Engl J Med 2005; 352: 2487–2498.
Richardson PG, Weller E, Lonial S, Jakubowiak AJ, Jagannath S, Raje NS et al. Lenalidomide, bortezomib, and dexamethasone combination therapy in patients with newly diagnosed multiple myeloma. Blood 2010; 116: 679–686.
Moreau P, Avet-Loiseau H, Facon T, Attal M, Tiab M, Hulin C et al. Bortezomib plus dexamethasone versus reduced-dose bortezomib, thalidomide plus dexamethasone as induction treatment before autologous stem cell transplantation in newly diagnosed multiple. Blood 2011; 118: 5752.
Shah N, Ahmed F, Bashir Q, Qureshi S, Dinh Y, Rondon G et al. Durable remission with salvage second auto-transplants in patients with multiple myeloma. Cancer 2012; 118: 3549–3555.
Jimenez-Zepeda VH, Mikhael J, Winter A, Franke N, Masih-Khan E, Trudel S et al. Second autologous stem cell transplantation as salvage therapy for multiple myeloma: impact on progression-free and overall survival. Biol Blood Marrow Transplant 2012; 18: 773–779.
Olin RL, Vogl DT, Porter DL, Luger SM, Schuster SJ, Tsai DE et al. Second auto-SCT is safe and effective salvage therapy for relapsed multiple myeloma. Bone marrow Transplant 2009; 43: 417–422.
Fenk R, Liese V, Neubauer F, Bruns I, Kondakci M, Balleisen S et al. Predictive factors for successful salvage high-dose therapy in patients with multiple myeloma relapsing after autologous blood stem cell transplantation. Leuk Lymphoma 2011; 52: 1455–1462.
Alvares CL, Davies FE, Horton C, Patel G, Powles R, Morgan GJ . The role of second autografts in the management of myeloma at first relapse. Haematologica 2006; 91: 141–142.
Burzynski JA, Toro JJ, Patel RC, Lee S, Greene RE, Ochoa-Bayona JL et al. Toxicity of a second autologous peripheral blood stem cell transplant in patients with relapsed or recurrent multiple myeloma. Leuk Lymphoma 2009; 50: 1442–1447.
Mehta J, Tricot G, Jagannath S, Ayers D, Singhal S, Siegel D et al. Salvage autologous or allogeneic transplantation for multiple myeloma refractory to or relapsing after a first-line autograft? Bone Marrow Transplant 1998; 21: 887–892.
Elice F, Raimondi R, Tosetto A, DEmilio A, Di Bona E, Piccin A et al. Prolonged overall survival with second on-demand autologous transplant in multiple myeloma. Am J Hematol 2006; 81: 426–431.
Silva Rondon C, Hassoun H, Chimento D, Jia X, Giralt S, Landau HJ . Outcomes following salvage autologous stem cell transplant for multiple myeloma. Biol Blood Marrow Transplant 2012; 18: S254.
Durie BG, Harousseau JL, Miguel JS, Bladé J, Barlogie B, Anderson K et al. International uniform response criteria for multiple myeloma. Leukemia 2006; 20: 1467–1473.
Corradini P, Voena C, Tarella C, Astolfi M, Ladetto M, Palumbo A et al. Molecular and clinical remissions in multiple myeloma: role of autologous and allogeneic transplantation of hematopoietic cells. J Clin Oncol 1999; 17: 208–215.
Kumar S, Mahmood ST, Lacy MQ, Dispenzieri A, Hayman SR, Buadi FK et al. Impact of early relapse after auto-SCT for multiple myeloma. Bone Marrow Transplant 2008; 42: 413–420.
Greipp PR, Katzmann JA, O'Fallon WM, Kyle RA . Value of beta-2-microglobulin level and plasma cell labeling indices as prognostic factors in patients with newly diagnosed myeloma. Blood 1988; 72: 219–223.
Weber DM, Chen C, Niesvizky R, Wang M, Belch A, Stadtmauer EA et al. Lenalidomide plus dexamethasone for relapsed multiple myeloma in North America. N Engl J Med 2007; 357: 2133–2142.
Mileshkin L, Biagi JJ, Mitchell P, Underhill C, Grigg A, Bell R et al. Multicenter phase 2 trial of thalidomide in relapsed/refractory multiple myeloma: adverse prognostic impact of advanced age. Blood 2003; 102: 69–77.
Richardson PG, Sonneveld P, Schuster M, Irwin D, Stadtmauer E, Facon T et al. Extended follow-up of a phase 3 trial in relapsed multiple myeloma: final time-to-event results of the APEX trial. Blood 2007; 110: 3557–3560.
Palumbo A, Rajkumar SV, Dimopoulos MA, Richardson PG, San Miguel J, Barlogie B et al. Prevention of thalidomide- and lenalidomide-associated thrombosis in myeloma. Leukemia 2008; 22: 414–423.
Reece D, Gill W, Masih-Khan E, Jacks L, Chen C, Kukreti V et al. Efficacy of lenalidomide therapy in patients with relapsed/refractory multiple myeloma: influence of number and timing of prior ASCT(s). Haematologica 2011 (Supplement 1: S106).
Acknowledgements
This work is supported in part by Mayo Clinic Hematological Malignancies Program, Paul Calabresi K12 Award (CA96028). Supported in part by grants CA 107476, CA 62242, CA100707 and CA 83724 from the National Cancer Institute, Rockville, MD, USA. Also supported in part by the Jabbs Foundation, Birmingham, UK and the Henry J Predolin Foundation, USA.
Author contributions: SKK designed the study, collected and analyzed the data and wrote the manuscript; WIG collected the data and contributed to writing the manuscript; AD, MQL, MAG, SRH, FKB, DD and WJH contributed to writing and reviewing the manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Gonsalves, W., Gertz, M., Lacy, M. et al. Second auto-SCT for treatment of relapsed multiple myeloma. Bone Marrow Transplant 48, 568–573 (2013). https://doi.org/10.1038/bmt.2012.183
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/bmt.2012.183
Keywords
This article is cited by
-
Trends in utilization of stored cryopreserved autologous peripheral hematopoietic cells intended for a second (or beyond) autologous hematopoietic cell transplantation in patients with multiple myeloma: a single center experience
Bone Marrow Transplantation (2023)
-
The changing landscape of relapsed and/or refractory multiple myeloma (MM): fundamentals and controversies
Biomarker Research (2022)
-
Autologous hematopoietic cell transplantation for relapsed multiple myeloma performed with cells procured after previous transplantation–study on behalf of CMWP of the EBMT
Bone Marrow Transplantation (2022)
-
Salvage second transplantation in relapsed multiple myeloma
Leukemia (2021)
-
The impact of re-induction prior to salvage autologous stem cell transplantation in multiple myeloma
Bone Marrow Transplantation (2019)