Second autologous transplant as salvage therapy in multiple myeloma

TY - JOUR

T1 - Second autologous transplant as salvage therapy in multiple myeloma

AU - Atanackovic, Djordje

AU - Schilling, Georgia

N1 - © 2013 John Wiley & Sons Ltd.

PY - 2013/12/1

Y1 - 2013/12/1

N2 - High-dose chemotherapy followed by autologous haematopoetic stem cell transplantation (ASCT) is a standard frontline therapy for multiple myeloma (MM). Unfortunately, there are no randomized clinical studies examining the role of a second ASCT in patients who relapse after the initial autotransplant. Analysing all available retrospective studies, it seems that salvage ASCT can safely be performed in most patients with an overall treatment-related mortality rate <5%. Approximately 65% of patients will achieve an objective response and progression-free and overall survival will be around 12 months and 32 months, respectively. Retrospective data suggest that patients with a progression-free survival of ≥18 months after initial ASCT are most likely to benefit from a salvage autotransplant. However, patients with a <12-month duration of response after initial ASCT should not be considered for a second autograft in the relapsed setting because this group will probably only experience ASCT-related toxicity without any clinical benefit. Quality of response after initial ASCT and number of therapies preceding salvage ASCT may also have a predictive value. Importantly, these findings need to be verified by randomized clinical trials in order to firmly integrate salvage ASCT into a global therapeutic concept for myeloma patients including optimized induction, consolidation, and maintenance approaches.

AB - High-dose chemotherapy followed by autologous haematopoetic stem cell transplantation (ASCT) is a standard frontline therapy for multiple myeloma (MM). Unfortunately, there are no randomized clinical studies examining the role of a second ASCT in patients who relapse after the initial autotransplant. Analysing all available retrospective studies, it seems that salvage ASCT can safely be performed in most patients with an overall treatment-related mortality rate <5%. Approximately 65% of patients will achieve an objective response and progression-free and overall survival will be around 12 months and 32 months, respectively. Retrospective data suggest that patients with a progression-free survival of ≥18 months after initial ASCT are most likely to benefit from a salvage autotransplant. However, patients with a <12-month duration of response after initial ASCT should not be considered for a second autograft in the relapsed setting because this group will probably only experience ASCT-related toxicity without any clinical benefit. Quality of response after initial ASCT and number of therapies preceding salvage ASCT may also have a predictive value. Importantly, these findings need to be verified by randomized clinical trials in order to firmly integrate salvage ASCT into a global therapeutic concept for myeloma patients including optimized induction, consolidation, and maintenance approaches.

KW - Angiogenesis Inhibitors

KW - Antineoplastic Combined Chemotherapy Protocols

KW - Bone Marrow Transplantation

KW - Boronic Acids

KW - Clinical Trials as Topic

KW - Disease-Free Survival

KW - Humans

KW - Interferon-alpha

KW - Maintenance Chemotherapy

KW - Multicenter Studies as Topic

KW - Multiple Myeloma

KW - Peripheral Blood Stem Cell Transplantation

KW - Pyrazines

KW - Recurrence

KW - Reoperation

KW - Retrospective Studies

KW - Salvage Therapy

KW - Thalidomide

KW - Transplantation Conditioning

KW - Transplantation, Autologous

KW - Treatment Outcome

U2 - 10.1111/bjh.12579

DO - 10.1111/bjh.12579

M3 - SCORING: Journal article

C2 - 24111632

VL - 163

SP - 565

EP - 572

JO - BRIT J HAEMATOL

JF - BRIT J HAEMATOL

SN - 0007-1048

IS - 5

ER -