The landscape of treatment for relapsed multiple myeloma has evolved in recent years. Second salvage autologous hematopoietic stem cell transplantation (AHCT) remains an option in these patients, but its use varies widely, according to a recently published letter to the editor.

“Choosing therapy in relapsed multiple myeloma is becoming increasingly complex in the crowded space of emerging and existing therapies,” the researchers wrote.

To assess the use of second AHCT, researchers from the Medical College of Wisconsin and the University of Arkansas examined outcomes of 975 patients who underwent second transplant between 2010 and 2015 in the United States and Canada after relapse following first transplant.

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With a median follow-up of 38 months, the rate of nonrelapse mortality was 1% at day 100, 1% at day 1 year, and 2% at 3 years. Cumulative incidence of relapse/progression at 1 year was 49%, increasing to 84% at 3 years.

Those patients who relapsed 3 years or later after first transplant had significantly lower incidence of relapse or progression after second transplant compared with those patients who relapsed between 24 and 35 months after first transplant (P =.02).

Additionally, those patients who relapsed 3 years or later after first transplant had significantly better progression-free (P =.01) and overall survival (P =.02) compared with those who relapsed earlier.

Disease status prior to second transplant was prognostic for relapse/progression, progression-free survival, and overall survival. Those patients who achieved very good partial response or better prior to second transplant had lower risk for relapse/progression and better progression-free survival compared with patients with partial response or stable disease.

“The outcomes reported in our study are comparable with some of the new approved FDA regimens in that space,” the researchers wrote.


Dhakal B, D’Souza A, Kleman A, et al. Salvage second transplantation in relapsed multiple myeloma. Leukemia. Published August 4, 2020. doi:10.1038/s41375-020-1005-8