Significance of salvage autologous stem cell transplantation (ASCT) for patients with multiple myeloma relapsing after up-front ASCT

Tsuyoshi Muta; Toshihiro Miyamoto; Tomoaki Fujisaki; Koichi Osaki; Ryosuke Ogawa; Koji Kato; Kenichi Aoki; Takashi Haro; Tomohiko Kamimura; Kenjiro Kamezaki; Goichi Yoshimoto; Satoshi Yamasaki; Katsuto Takenaka; Yuju Ohno; Hiromi Iwasaki; Testuya Eto; Koji Nagafuji; Koichi Akashi; Fukuoka Blood and Marrow Transplant Group (FBMTG)

doi:10.7889/hct.6.98

Original Article

Significance of salvage autologous stem cell transplantation (ASCT) for patients with multiple myeloma relapsing after up-front ASCT

Tsuyoshi Muta, Toshihiro Miyamoto, Tomoaki Fujisaki, Koichi Osaki, Ryosuke Ogawa, Koji Kato, Kenichi Aoki, Takashi Haro, Tomohiko Kamimura, Kenjiro Kamezaki, Goichi Yoshimoto, Satoshi Yamasaki, Katsuto Takenaka, Yuju Ohno, Hiromi Iwasaki, Testuya Eto, Koji Nagafuji, Koichi Akashi, Fukuoka Blood and Marrow Transplant Group (FBMTG)

Author information

Tsuyoshi Muta
Department of Hematology/Oncology, Japan Community Health Care Organization (JCHO) Kyushu Hospital, Fukuoka
Toshihiro Miyamoto
Department of Hematology/Oncology, Kyushu University Hospital, Fukuoka
Tomoaki Fujisaki
Department of Internal Medicine, Matsuyama Red-Cross Hospital, Ehime
Koichi Osaki
Division of Hematology and Oncology, department of medicine, Kurume University School of medicine, Fukuoka
Ryosuke Ogawa
Department of Hematology/Oncology, Japan Community Health Care Organization (JCHO) Kyushu Hospital, Fukuoka
Koji Kato
Department of Hematology/Oncology, Kyushu University Hospital, Fukuoka
Kenichi Aoki
Department of Hematology/Oncology, Japan Community Health Care Organization (JCHO) Kyushu Hospital, Fukuoka
Takashi Haro
Department of Internal Medicine, Matsuyama Red-Cross Hospital, Ehime
Tomohiko Kamimura
Department of Hematology, Hara-Sanshin Hospital, Fukuoka
Kenjiro Kamezaki
Department of Hematology/Oncology, Kyushu University Hospital, Fukuoka
Goichi Yoshimoto
Department of Hematology/Oncology, Kyushu University Hospital, Fukuoka
Satoshi Yamasaki
Department of Hematology, National Hospital Organization Kyushu Medical Center, Fukuoka
Katsuto Takenaka
Department of Hematology/Oncology, Kyushu University Hospital, Fukuoka
Yuju Ohno
Department of Hematology, Kita-kyushu Municipal Medical Center, Fukuoka
Hiromi Iwasaki
Department of Hematology, National Hospital Organization Kyushu Medical Center, Fukuoka
Testuya Eto
Department of Hematology, Hamanomachi Hospital, Fukuoka
Koji Nagafuji
Division of Hematology and Oncology, department of medicine, Kurume University School of medicine, Fukuoka
Koichi Akashi
Department of Hematology/Oncology, Kyushu University Hospital, Fukuoka
Fukuoka Blood and Marrow Transplant Group (FBMTG)

Keywords: relapsed multiple myeloma, autologous stem cell transplantation, salvage therapy, novel agents

JOURNAL FREE ACCESS

2017 Volume 6 Issue 2 Pages 98-107

DOI https://doi.org/10.7889/hct.6.98

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Abstract

We retrospectively analyzed data from 60 patients who had relapsed after up-front autologous stem cell transplantation (ASCT). Thirteen patients received salvage ASCT, and median progression-free survival (PFS) and overall survival (OS) after salvage ASCT were 19.3 and 41.1 months, respectively. Favorable factors for PFS after salvage ASCT were as follows; achieving a partial or better response before salvage ASCT [hazard ratio (HR) =0.018, 95% confidence interval (CI): 0.005-0.64, P=0.028] and consolidation/maintenance therapy after salvage ASCT (HR=0.083, 95% CI: 0.008-0.87, P=0.038). There was no significant factor for OS after salvage ASCT. Patients without salvage ASCT had not been surveyed for PFS after relapse. Including all patients, two unfavorable factors for OS after relapse were as follows; relapsing during or after consolidation/maintenance therapy after initial ASCT and salvage therapy comprising cytotoxic agents. On the other hand, salvage ASCT was favorable for OS after relapse post initial ASCT (HR=0.30, 95% CI: 0.096-0.95, P=0.041). Confounding factors and survivor treatment selection bias do not permit definitive conclusion. We hope the current study sheds light on the salvage ASCT, but careful evaluation is needed during the approval of additional new agents.

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