Prognostic Factors for Postrelapse Survival after ex Vivo CD34

Aged Disease-Free Survival Hematopoietic Stem Cell Transplantation Humans Middle Aged Multiple Myeloma / therapy Neoplasm Recurrence, Local Prognosis Retrospective Studies T-Lymphocytes Transplantation Conditioning
Allogeneic hematopoietic stem cell transplantation CD34(+) selection Donor lymphocyte infusion Multiple myeloma Relapse T cell depletion

Journal

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
ISSN: 1523-6536
Titre abrégé: Biol Blood Marrow Transplant
Pays: United States
ID NLM: 9600628

Informations de publication

Date de publication:
11 2020
Historique:
received: 20 05 2020
revised: 12 07 2020
accepted: 12 07 2020
pubmed: 28 7 2020
medline: 24 6 2021
entrez: 27 7 2020
Statut: ppublish

Résumé

Allogeneic hematopoietic cell transplantation (alloHCT) for multiple myeloma (MM), with its underlying graft-versus-tumor capacity, is a potentially curative approach for high-risk patients. Relapse is the main cause of treatment failure, but predictors for postrelapse survival are not well characterized. We conducted a retrospective analysis to evaluate predictors for postrelapse overall survival (OS) in 60 MM patients who progressed after myeloablative T cell-depleted alloHCT. The median patient age was 56 years, and 82% had high-risk cytogenetics. Patients received a median of 4 lines of therapy pre-HCT, and 88% achieved at least a partial response (PR) before alloHCT. Of the 38% who received preemptive post-HCT therapy, 13 received donor lymphocyte infusions (DLIs) and 10 received other interventions. Relapse was defined as very early (<6 months; 28%), early (6 to 24 months; 50%), or late (>24 months; 22%). At relapse, 27% presented with extramedullary disease (EMD). The median postrelapse overall survival (OS) by time to relapse was 4 months for the very early relapse group, 17 months for the early relapse group, and 72 months for the late relapse group (P = .002). Older age, relapse with EMD, <PR before alloHCT, <PR by day +100, and no maintenance were prognostic for inferior postrelapse OS on univariate analysis. On multivariate analysis adjusted for age and sex, very early relapse (hazard ratio [HR], 4.37; 95% confidence interval [CI], 1.42 to 13.5), relapse with EMD (HR, 5.20; 95% CI, 2.10 to 12.9), and DLI for relapse prevention (HR, .11; 95% CI, 2.10 to 12.9) were significant predictors for postrelapse survival. Despite their shared inherent high-risk status, patients with MM have significantly disparate post-HCT relapse courses, with some demonstrating long-term survival despite relapse.

Identifiants

DOI: 10.1016/j.bbmt.2020.07.016 PMID: 32712326 PMC: PMC7609585
pubmed: 32712326
pii: S1083-8791(20)30447-X
doi: 10.1016/j.bbmt.2020.07.016
pmc: PMC7609585
mid: NIHMS1615987
pii:
doi:

Types de publication

Journal Article Research Support, N.I.H., Extramural

Langues

eng

Sous-ensembles de citation

IM

Pagination

2040-2046

Subventions

Organisme : NCI NIH HHS
ID : P01 CA023766
Pays : United States
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States

Informations de copyright

Copyright © 2020 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.

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Auteurs

Alexandra Gomez-Arteaga (A)

Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.

Gunjan L Shah (GL)

Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.

Raymond E Baser (RE)

Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.

Michael Scordo (M)

Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.

Josel D Ruiz (JD)

Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York.

Adam Bryant (A)

Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Hematology, Peter Lougheed Centre, Calgary, Canada.

Parastoo B Dahi (PB)

Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.

Arnab Ghosh (A)

Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.

Oscar B Lahoud (OB)

Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.

Heather J Landau (HJ)

Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.

Ola Landgren (O)

Department of Medicine, Weill Cornell Medical College, New York, New York; Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, New York.

Brian C Shaffer (BC)

Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.

Eric L Smith (EL)

Department of Medicine, Weill Cornell Medical College, New York, New York; Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, New York.

Guenther Koehne (G)

Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Miami Cancer Institute, Miami, Florida.

Miguel-Angel Perales (MA)

Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.

Sergio A Giralt (SA)

Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.

David J Chung (DJ)

Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York; The Rockefeller University, New York, New York. Electronic address: chungd1@mskcc.org.

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Classifications MeSH

Recherchemedicale.com › Personnes › Tranches d'âge › Adulte › Sujet âgé › Prognostic Factors for Postrelapse Survival...
Recherchemedicale.com › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Analyse de survie › Survie sans rechute › Prognostic Factors for Postrelapse Survival...
Recherchemedicale.com › Procédures de chirurgie opératoire › Transplantation › Transplantation cellulaire › Transplantation de cellules souches › Transplantation de cellules souches hématopoïétiques › Prognostic Factors for Postrelapse Survival...
Recherchemedicale.com › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Prognostic Factors for Postrelapse Survival...
Recherchemedicale.com › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Prognostic Factors for Postrelapse Survival...
Recherchemedicale.com › Maladies du système immunitaire › Syndromes immunoprolifératifs › Paraprotéinémies › Myélome multiple › Prognostic Factors for Postrelapse Survival...
Recherchemedicale.com › États, signes et symptômes pathologiques › Processus pathologiques › Processus néoplasiques › Récidive tumorale locale › Prognostic Factors for Postrelapse Survival...
Recherchemedicale.com › Diagnostic › Pronostic › Prognostic Factors for Postrelapse Survival...
Recherchemedicale.com › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Prognostic Factors for Postrelapse Survival...
Recherchemedicale.com › Systèmes sanguin et immunitaire › Système immunitaire › Leucocytes › Agranulocytes › Lymphocytes › Lymphocytes T › Prognostic Factors for Postrelapse Survival...
Recherchemedicale.com › Techniques d'investigation › Techniques immunologiques › Immunosuppression thérapeutique › Conditionnement pour greffe › Prognostic Factors for Postrelapse Survival...