Cancer Therapy Advisor: Did the timing of transplantation (up-front vs salvage), or single- vs tandem, affect outcomes among patients undergoing allo-transplant at Mayo Clinic?

Dr Mir: This is a very interesting aspect of allo-transplant. It did not show much difference in this study, but I do not think we’ll be able to persuade an institutional review board to allow us to run an upfront allo-transplant study for myeloma in this day and age, because there are more than 15 drug options available, and counting. Almost all patients had failed 1 or 2 auto-transplants before moving to allo-transplant.


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The Mayo Clinic does not do tandem transplants for myeloma at the present time. Data supporting tandem transplants are controversial.3

Cancer Therapy Advisor: How did the Mayo Clinic experience compare with those reported for other centers? What are the clinical lessons or implications of your analysis of the Mayo series? 

Dr Mir: We looked at other institutional data, which as expected were quite diverse depending upon upfront vs salvage allo-transplant, conditioning regimens and use of proteasome inhibitors/immunomodulators. European Group for Blood and Marrow Transplantation (EBMT)4 data showed a PFS of 22 months and overall survival of 49%. Center for International Blood and Marrow Transplant Research (CIBMTR )5 data were closer to our findings with PFS of 14 months and overall survival of 29%.

I think allo-transplant should be offered to patients who are not eligible for an available clinical trial and have good performance status and high-risk disease. Long-term survival of 20% to 30% is better than hospice and may bridge them to a new drug in the pipeline.

References

  1. Mir MA, Kapoor P, Kumar S, et al. Trends in outcomes in allogeneic hematopoietic stem cell transplant for multiple myeloma at Mayo Clinic. Clin Lymphoma Myeloma Leuk. 2015;15(6):349-357.
  2. Kikuchi T, Mori T, Koda Y, et al. Outcome of reduced-intensity allogeneic hematopoietic stem cell transplantation for multiple myeloma. Int J Hematol. 2015;102(6):670-677.
  3. Kharfan-Dabaja MA, Hamadani M, Reljic T, et al. Comparative efficacy of tandem autologous versus autologous followed by allogeneic hematopoietic cell transplantation in patients with newly diagnosed multiple myeloma: a systematic review and meta-analysis of randomized controlled trials. J Hematol Oncol. 2013;6:2. doi: 10.1186/1756-8722-6-2.
  4. Auner HW, Szydlo R, van Biezen A, et al. Reduced intensity-conditioned allogeneic stem cell transplantation for multiple myeloma relapsing or progressing after autologous transplantation: a study by the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant. 2013;48(11):1395-1400.
  5. Kumar S, Zhang MJ, Li P, et al. Trends in allogeneic stem cell transplantation for multiple myeloma: a CIBMTR analysis. Blood. 2011;118(7):1979-1988.