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Abstract
Progression or relapse occurs in the vast majority of patients with multiple myeloma (MM) who undergo up-front autologous hematopoietic cell transplantation (AHCT1), which remains a cornerstone of treatment in the era of novel agents. Limited data are available regarding the value of salvage therapy with a second AHCT (AHCT2) in patients who relapse/progress after AHCT1. We analyzed the outcome of 83 patients who underwent salvage AHCT2 between 1994 and 2011. Most patients (77%) had received treatment with novel agents between AHCT1 and AHCT2, and 28% of patients were from ethnic minority groups. Median overall survival (OS) from AHCT2 was 31.5 months (95% confidence interval [CI]: 22–41), and median progression-free survival (PFS) was 15.5 months (95% CI: 11–20). In multivariate analysis, only disease status (≥ PR) at AHCT2 was associated with better OS. The 3-year OS rates for patients receiving AHCT2 in > PR and PR were 85.9% (95% CI: 61–96) and 51.3% (95% CI: 34–68), respectively. Disease status at AHCT2 and time to progression/relapse after AHCT1 were associated with PFS in multivariate analysis. In summary, salvage AHCT2 is an effective treatment option in patients with chemosensitive relapse/progression and prolonged remission after a prior autograft.
Potential conflict of interest:
Disclosure forms provided by the authors are available with the full text of this article at www.informahealthcare.com/la.
H.W.A. is supported by a Cancer Research UK Clinician Scientist Fellowship and received support from Leuka while conducting this study. H.W.A., J.F.A., E.K., D.H.M., D.Mil., D.Mar., J.P. and A.R. acknowledge the support of the NIHR Biomedical Research Centre funding.
Notice of Correction
The version of this article published online ahead of print on 4th March 2013 contained an error. The term ‘Transplantation’ was shortened to ‘Transplant’ throughout the article. The error has been corrected for this version.