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Novel agent-based salvage autologous stem cell transplantation for relapsed multiple myeloma

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Abstract

High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is a standard frontline therapy for multiple myeloma (MM). Therapeutic options for patients with relapsed MM after ASCT include novel agents in different combos, salvage ASCT (sASCT), and allogeneic transplant, with no unique standard of care. We retrospectively analyzed 66 MM patients who relapsed after up-front single or double ASCT(s) and received novel agent-based sASCT at five Italian centers. Median event-free survival from up-front ASCT(s) to first relapse (EFS1) was 44 months. Seventy-three percent of patients received sASCT at first disease progression. Re-induction regimens were bortezomib based in 87% of patients. Response to re-induction therapy included complete response (CR) 18%, ≥ very good partial response (VGPR) 48%, and overall response rate (ORR) 83%. Response to sASCT included CR 44%, ≥ VGPR 77%, and ORR 94%. With a median follow-up of 24 months after sASCT, 39 patients experienced disease progression. Median EFS from sASCT (EFS2) was 17 months. Median overall survival from ASCT (OS1) and sASCT (OS2) was 166 and 43 months, respectively. EFS2 and OS2 were significantly shorter in patients with EFS1 ≤ 24 months, in patients who did not receive sASCT at first disease progression and in patients with extramedullary disease (EMD). In multivariate analysis, EFS1 ≤ 24 months was associated with shorter EFS2 and OS2, EMD was associated with shorter EFS2, and < CR after sASCT was associated with shorter OS2. Novel agent-based sASCT is a safe and effective procedure for relapsed MM.

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Authors and Affiliations

  1. “Seràgnoli” Institute of Hematology, Sant’Orsola-Malpighi University Hospital, Bologna, Italy

    Beatrice Anna Zannetti, Paola Tacchetti, Lucia Pantani, Serena Rocchi, Annalisa Pezzi, Katia Mancuso, Ilaria Rizzello, Isola Caratozzolo, Marina Martello, Luca Dozza, Michele Cavo & Elena Zamagni

  2. Hematology Unit, “Arcispedale Santa Maria Nuova – IRCCS” Hospital, Reggio Emilia, Italy

    Barbara Gamberi

  3. Hematology Unit, “Infermi” Hospital, Rimini, Italy

    Patrizia Tosi

  4. Hematology Unit, “S. Maria delle Croci” Hospital, Ravenna, Italy

    Claudia Cellini

  5. Oncology and Hematology Unit, “Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori” Hospital, Meldola, Italy

    Sonia Ronconi

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  1. Beatrice Anna Zannetti
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  2. Paola Tacchetti
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  3. Lucia Pantani
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  4. Barbara Gamberi
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  13. Marina Martello
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  14. Luca Dozza
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  15. Michele Cavo
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Correspondence to Michele Cavo.

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Conflict of interest

Michele Cavo has received honoraria and has been a member of the advisory board for Celgene, Janssen, Amgen, Takeda and Bristol-Myers Squibb. Elena Zamagni has received honoraria from Janssen-Cilag, Celgene and Amgen. All other authors declare to have no relevant financial interests in competing.

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Zannetti, B.A., Tacchetti, P., Pantani, L. et al. Novel agent-based salvage autologous stem cell transplantation for relapsed multiple myeloma. Ann Hematol 96, 2071–2078 (2017). https://doi.org/10.1007/s00277-017-3140-5

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  • DOI: https://doi.org/10.1007/s00277-017-3140-5

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