Second Autologous Stem Cell Transplant (ASCT) as
Salvage Therapy in Patients with Relapsed Multiple Myeloma
1Joseph Mikhael, MD; 2Sahar Zadeh; 1A. Keith Stewart, MD; 2Christine Chen, MD; 2Suzanne Trudel, MD; 2Vishal Kukreti, MD; 2Andrew Winter, BScN; 2Norman Franke; 2Donna E. Reece, MD
1Mayo Clinic Scottsdale, Arizona and 2Princess Margaret Hospital Toronto, Ontario, Canada
Background
Results
Conclusions
Single autologous stem cell transplant (ASCT) is
· Between February 1997 and July 2009, 79 patients with
Table 2: Outcomes Based on Time to Progression
1. 2nd ASCT is a feasible and safe
considered the standard of care after induction therapy for
MM received a second ASCT at our institution as
Post 1st ASCT
salvage therapy in relapsed
younger multiple myeloma (MM) patients. However, it is
salvage therapy
MM patients.
not curative and virtually all patients will ultimately
Median
Median
relapse. As more options are available to treat relapsed
· Time between transplants
PFS
OS
disease, the role of a second ASCT as salvage therapy
2. It is effective in providing a median
The median time from diagnosis to 1st ASCT was
No.
Post 2nd
Post 2nd
is unclear.
of
ASCT
ASCT
progression free survival of 18.5
9.7 months (2-74)
Group
Pts
(Months)
p value
(Months)
P value
months and median overall survival
The median time to relapse after the 1st transplant
of 4.4 years (52.8 months) after 2nd
Methods
was 2.72 years (0.81-8.26), with a median interval
Entire cohort
79
18.5
52.8
ASCT. This is comparable if not
between transplants of 3.61 years (1.63-9.59)
<24 months
15
12.7
42.2
better than modern salvage
Retrospective review of all MM pts who received a 2nd
· Outcomes
24-36 months
30
17.0
52.7
chemotherapies.
ASCT as salvage therapy at Princess Margaret Hospital
>36 months
34
32.6
0.0196
Not reached
0.1104
(Table 1).
2 transplant related deaths occurred
3. The longer the disease free interval
Response after 1st ASCT (in 78 evaluable patients):
Figure 1:
after 1st ASCT the more effective
Table 1: Patient Characteristics (n=79)
» CR/nCR
13 (17%)
PFS Based on Progression Free Interval After 1st ASCT
2nd ASCT is at extending both
Sex
progression free survival and overall
» VGPR/PR
56 (72%)
Male
48
survival.
Female
31
» MR/SD
9 (12%)
4. It is reasonable, therefore, to
Response after 2nd ASCT (in 73 evaluable patients):
Age (median at 2nd ASCT)
60 (39-72)
consider a 2nd ASCT if the time to
» CR/nCR
11 (15%)
progression is greater than 2 years
M Component
after first ASCT.
IgG
42
» VGPR/PR
57 (78%)
IgA
21
» MR/SD
6 (8%)
Light-Chain
11
Non-Secretory
3
· Survival
IgM
1
References
IgD
1
With a median follow up of 5.92 years after 2nd
ASCT, median progression-free survival (PFS) was
1. Attal NEJM 1996;335:91-7.
Conditioning
18.5 months while median overall survival (OS)
1st ASCT
was 4.4 years
2. Barlogie Blood 1997;89:789-93.
Melphalan alone (140-200 mg/m2)
67
Long-term progression-free status based on the
Melphalan + TBI ± Etoposide
11
3. Child NEJM 2003;348:1875-83.
progression-free interval after 1st ASCT is
Busulfan + Cyclophosphamide
1
summarized Table 2
2nd ASCT
4. Sirohi BMT 29:S12, 2002 (suppl 2).
Melphalan Alone
76
PFS based on progression free interval after 1st
Melphalan + TBI ± Etoposide
3
ASCT is outlined in Figure 1
5. Morris JCO 2004;22:1674-81.