Response to Novel Drugs before and after Allogeneic Stem Cell Transplantation in Patients with Relapsed Multiple Myeloma
López Corral, Lucia (Complejo Asistencial Universitario de Salamanca. Instituto de Investigación Biomédica de Salamanca)
Caballero Velazquez, Teresa (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
López-Godino, Oriana (Hospital Universitario Morales Meseguer y Centro Regional de Hemodonación. IMIB. Universidad de Murcia)
Rosiñol, Laura (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Pérez-Vicente, Sabina (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Fernandez Aviles, Francesc (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Krsnik, Isabel (Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana)
Morillo, Daniel (Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana)
Heras, Inmaculada (Hospital Universitario Morales Meseguer y Centro Regional de Hemodonación. IMIB. Universidad de Murcia)
Morgades, Mireia (Institut Germans Trias i Pujol. Institut de Recerca contra la Leucèmia Josep Carreras)
Rifon, Jose (Clínica Universidad de Navarra. Centro de Investigación Médica Aplicada)
Sampol, Antonia (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Iniesta, Francisca (Hospital Universitario Virgen de la Arrixaca (Múrcia))
Ocio, Enrique M. (Complejo Asistencial Universitario de Salamanca. Instituto de Investigación Biomédica de Salamanca)
Martin, Jesús (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Rovira Tarrats, Montserrat (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Cabero, Martín (Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana)
Castilla-Llorente, Cristina (Hematology Department. Gustave Roussy Cancer Center)
Ribera, Jose-Maria (Institut Germans Trias i Pujol. Institut de Recerca contra la Leucèmia Josep Carreras)
Torres-Juan, Marta (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Moraleda, José María (Hospital Universitario Virgen de la Arrixaca (Múrcia))
Martinez, Carmen (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Vázquez, Alejandro (Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana)
Gutiérrez-García, Gonzalo (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Caballero, Dolores (Complejo Asistencial Universitario de Salamanca. Instituto de Investigación Biomédica de Salamanca)
San-Miguel, J (Clínica Universidad de Navarra. Centro de Investigación Médica Aplicada)
Mateos, M. V (Complejo Asistencial Universitario de Salamanca. Instituto de Investigación Biomédica de Salamanca)
Pérez-Simón, José Antonio (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Universitat Autònoma de Barcelona

Date:	2019
Abstract:	Multiple myeloma (MM) remains as an incurable disease and, although allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative approach, most patients ultimately relapse, and their treatment remains challenging. Because allo-HSCT can modify not only the biology of the disease, but also the immune system and the microenvironment, it can potentially enhance the response to rescue therapies. Information on the efficacy and safety of novel drugs in patients relapsing after allo-HSCT is lacking, however. The objectives of this study were to evaluate the efficacy and toxicity of rescue therapies in patients with MM who relapsed after allo-HSCT, as well as to compare their efficacy before and after allo-HSCT. This retrospective multicenter study included 126 consecutive patients with MM who underwent allo-HSCT between 2000 and 2013 at 8 Spanish centers. All patients engrafted. The incidence of grade II-IV acute graft-versus-host disease (GVHD) was 47%, and nonrelapse mortality within the first 100 days post-transplantation was 13%. After a median follow-up of 92 months, overall survival (OS) was 51% at 2 years and 43% at 5 years. The median progression-free survival after allo-HSCT was 7 months, whereas the median OS after relapse was 33 months. Patients relapsing in the first 6 months after transplantation had a dismal prognosis compared with those who relapsed later (median OS, 11 months versus 120 months; P <. 001). The absence of chronic GVHD was associated with reduced OS after relapse (hazard ratio, 3. 44; P <. 001). Most patients responded to rescue therapies, including proteasome inhibitors (PIs; 62%) and immunomodulatory drugs (IMiDs; 77%), with a good toxicity profile. An in-depth evaluation, including the type and intensity of PI- and IMiD-based combinations used before and after allo-HSCT, showed that the overall response rate and duration of response after allo-HSCT were similar to those seen in the pretransplantation period. Patients with MM who relapse after allo-HSCT should be considered candidates for therapy with new drugs, which can achieve similar response rates with similar durability as seen in the pretransplantation period. This pattern does not follow the usual course of the disease outside the transplantation setting, where response rates and time to progression decreases with each consecutive line of treatment.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Allo-HSCT ; Allogeneic hematopoietic stem cell transplantation ; Immunomodulatory drug ; Multiple myeloma ; Proteasome inhibitor
Published in:	Biology of blood and marrow transplantation, Vol. 25 Núm. 9 (september 2019) , p. 1703-1712, ISSN 1523-6536

DOI: 10.1016/j.bbmt.2019.04.026
PMID: 31054983

10 p, 582.3 KB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP) > Josep Carreras Leukaemia Research Institute
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