Tandem Autologous-Autologous versus Autologous-Allogeneic Hematopoietic Stem Cell Transplant for Patients with Multiple Myeloma: Long-Term Follow-Up Results from the Blood and Marrow Transplant Clinical Trials Network 0102 Trial.

TitleTandem Autologous-Autologous versus Autologous-Allogeneic Hematopoietic Stem Cell Transplant for Patients with Multiple Myeloma: Long-Term Follow-Up Results from the Blood and Marrow Transplant Clinical Trials Network 0102 Trial.
Publication TypeJournal Article
Year of Publication2020
AuthorsGiralt, S, Costa, LJ, Maloney, D, Krishnan, A, Fei, M, Antin, JH, Brunstein, C, Geller, N, Goodman, S, Hari, P, Logan, B, Lowsky, R, Qazilbash, MH, Sahebi, F, Somlo, G, Rowley, S, Vogl, DT, Vesole, DH, Pasquini, M, Stadtmauer, E
JournalBiol Blood Marrow Transplant
Volume26
Issue4
Pagination798-804
Date Published2020 04
ISSN1523-6536
KeywordsBone Marrow, Disease-Free Survival, Follow-Up Studies, Hematopoietic Stem Cell Transplantation, Humans, Multiple Myeloma, Neoplasm Recurrence, Local, Transplantation, Autologous, Transplantation, Homologous
Abstract

Allogeneic hematopoietic cell transplant (HCT) may improve long-term multiple myeloma (MM) control through the graft-versus-myeloma effect. The Blood and Marrow Transplant Clinical Trials Network 0102 trial was a biologic assignment trial comparing tandem autologous transplant (auto-auto) versus autologous followed by reduced-intensity allogeneic (auto-allo) transplant in patients with newly diagnosed MM with standard-risk (n = 625) or high-risk (n = 85; β-microglobulin at diagnosis ≥ 4 mg/dL or deletion of chromosome 13 by conventional karyotyping) disease. Although the initial 3-year analysis showed no difference in progression-free survival (PFS) between arms in either risk group, we hypothesized that long-term follow-up may better capture the impact of the graft-versus-myeloma effect. Median follow-up of survivors was over 10 years. Among standard-risk patients there was no difference in PFS (hazard ratio [HR], 1.11; 95% confidence interval [CI], .93 to 1.35; P = .25) or OS (HR, 1.03; 95% CI, .82 to 1.28; P = .82). The 6-year PFS was 25% in the auto-auto arm versus 22% in the auto-allo arm (P = .32), and 6-year overall survival (OS) was 60% and 59%, respectively (P = .85). In the high-risk group, although there was no statistically significant difference in PFS (HR, .66; 95% CI, .41 to 1.07; P = .07) and OS (HR, 1.01; 95% CI, .60 to 1.71; P = .96), a reduction in 6-year risk of relapse of 77% versus 47% (P = .005) was reflected in better PFS of 13% versus 31% (P = .05) but similar OS, at 47% versus 51% (P = .69). Allogeneic HCT can lead to long-term disease control in patients with high-risk MM and needs to be explored in the context of modern therapy.

DOI10.1016/j.bbmt.2019.11.018
Alternate JournalBiol Blood Marrow Transplant
PubMed ID31756536
PubMed Central IDPMC7198329
Grant ListUG1 HL069286 / HL / NHLBI NIH HHS / United States
UG1 HL069278 / HL / NHLBI NIH HHS / United States
P30 CA008748 / CA / NCI NIH HHS / United States
U01 HL069294 / HL / NHLBI NIH HHS / United States
U01 HL069334 / HL / NHLBI NIH HHS / United States
U10 CA180888 / CA / NCI NIH HHS / United States
U10 HL069315 / HL / NHLBI NIH HHS / United States
U24 CA076518 / CA / NCI NIH HHS / United States
U24 HL138660 / HL / NHLBI NIH HHS / United States