Tandem Autologous/Allogeneic HCT With Maintenance Therapy in High-Risk Myeloma

Key Points

  • Tandem autologous/allogeneic HCT and bortezomib maintenance produced good results in newly diagnosed patients with high-risk multiple myeloma.
  • Outcomes with this treatment approach were poorer in previously treated patients.

In a phase II study reported in Blood Advances, Green et al found that tandem autologous/allogeneic hematopoietic cell transplantation (HCT) followed by bortezomib (Velcade) maintenance produced good results in patients with newly diagnosed high-risk multiple myeloma. Poorer outcomes were observed in previously treated patients.

Study Details

The study enrolled 31 patients between 2009 and 2014. Of 24 newly diagnosed patients, 17 had high-risk cytogenetics and 7 had high-risk disease on the basis of serum β2 microglobulin level > 5.5 g/dL. Seven patients were enrolled on the basis of relapsed disease after previous autologous HCT (n = 6) or induction treatment failure (n = 1); these patients had a median of three prior treatment regimens.

High-dose conditioning for autologous HCT consisted of melphalan at 200 mg/m2. Nonmyeloablative conditioning for allogeneic HCT involved low-dose total-body irradiation at 2 Gy with or without fludarabine at 30 mg/m2 for 3 days. Bortezomib maintenance was given at 1.6 mg/m2 intravenously or 2.6 mg/m2 subcutaneously every 14 days for 9 months.

Outcomes

Among the 31 patients, 26 (84%) received human leukocyte antigen (HLA)-matched allogeneic HCT at a median of 61 days (range = 41–168 days) after autologous HCT, and 21 patients (68%) started bortezomib maintenance at a median of 79 days (range = 63–103 days) after allogeneic HCT. On an intent-to-treat analysis at a median follow-up of 51 months (range = 16–86 months), 2- and 4-year progression-free survival rates were 71% and 52%, and 2- and 4-year overall survival rates were 75% and 61%, respectively, among the 24 newly diagnosed patients. Among the seven patients with relapsed/persistent disease, 2- and 4-year progression-free survival rates were 14% and 14%, and 2- and 4-year overall survival rates were 43% and 29%, respectively.

The investigators concluded: “These findings suggest that for patients with newly diagnosed high-risk multiple myeloma, bortezomib maintenance therapy after tandem autologous/allogeneic hematopoietic cell transplantation is safe and may prevent disease progression until full establishment of a graft-versus-myeloma effect. This benefit, however, does not extend to patients who enroll after unsuccessful prior therapy.”

The study was supported by the National Institutes of Health; the National Heart, Lung, and Blood Institute; and the National Cancer Institute as well as Millennium Pharmaceuticals, Inc/Takeda Oncology.

Marco Mielcarek, MD, of Fred Hutchinson Cancer Research Center, is the corresponding author of the Blood Advances article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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