TY - JOUR
T1 - Impact of second primary malignancy post–autologous transplantation on outcomes of multiple myeloma
T2 - a CIBMTR analysis
AU - Ragon, Brittany Knick
AU - Shah, Mithun Vinod
AU - D’Souza, Anita
AU - Estrada-Merly, Noel
AU - Gowda, Lohith
AU - George, Gemlyn
AU - de Lima, Marcos
AU - Hashmi, Shahrukh
AU - Kharfan-Dabaja, Mohamed A.
AU - Majhail, Navneet S.
AU - Banerjee, Rahul
AU - Saad, Ayman
AU - Hildebrandt, Gerhard C.
AU - Mian, Hira
AU - Abid, Muhammad Bilal
AU - Battiwalla, Minoo
AU - Lekakis, Lazaros J.
AU - Patel, Sagar S.
AU - Murthy, Hemant S.
AU - Nieto, Yago
AU - Strouse, Christopher
AU - Badawy, Sherif M.
AU - Al Hadidi, Samer
AU - Dholaria, Bhagirathbhai
AU - Aljurf, Mahmoud
AU - Vesole, David H.
AU - Lee, Cindy H.
AU - Pawarode, Attaphol
AU - Gergis, Usama
AU - Miller, Kevin C.
AU - Holmberg, Leona A.
AU - Afrough, Aimaz
AU - Solh, Melhem
AU - Munshi, Pashna N.
AU - Nishihori, Taiga
AU - Anderson, Larry D.
AU - Wirk, Baldeep
AU - Kaur, Gurbakhash
AU - Qazilbash, Muzaffar H.
AU - Shah, Nina
AU - Kumar, Shaji K.
AU - Usmani, Saad Z.
N1 - Publisher Copyright:
© 2023 by The American Society of Hematology.
PY - 2023/6
Y1 - 2023/6
N2 - The overall survival (OS) has improved significantly in multiple myeloma (MM) over the last decade with the use of proteasome inhibitor and immunomodulatory drug-based combinations, followed by high-dose melphalan and autologous hematopoietic stem cell transplantation (auto-HSCT) and subsequent maintenance therapies in eligible newly diagnosed patients. However, clinical trials using auto-HSCT followed by lenalidomide maintenance have shown an increased risk of second primary malignancies (SPM), including second hematological malignancies (SHM). We evaluated the impact of SPM and SHM on progression-free survival (PFS) and OS in patients with MM after auto-HSCT using CIBMTR registry data. Adult patients with MM who underwent first auto-HSCT in the United States with melphalan conditioning regimen from 2011 to 2018 and received maintenance therapy were included (n = 3948). At a median follow-up of 37 months, 175 (4%) patients developed SPM, including 112 (64%) solid, 36 (20%) myeloid, 24 (14%) SHM, not otherwise specified, and 3 (2%) lymphoid malignancies. Multivariate analysis demonstrated that SPM and SHM were associated with an inferior PFS (hazard ratio [HR] 2.62, P < .001 and HR 5.01, P < .001, respectively) and OS (HR 3.85, P < .001 and HR 8.13, P < .001, respectively). In patients who developed SPM and SHM, MM remained the most frequent primary cause of death (42% vs 30% and 53% vs 18%, respectively). We conclude the development of SPM and SHM leads to a poor survival in patients with MM and is an important survivorship challenge. Given the median survival for MM continues to improve, continued vigilance is needed to assess the risks of SPM and SHM with maintenance therapy post–auto-HSCT.
AB - The overall survival (OS) has improved significantly in multiple myeloma (MM) over the last decade with the use of proteasome inhibitor and immunomodulatory drug-based combinations, followed by high-dose melphalan and autologous hematopoietic stem cell transplantation (auto-HSCT) and subsequent maintenance therapies in eligible newly diagnosed patients. However, clinical trials using auto-HSCT followed by lenalidomide maintenance have shown an increased risk of second primary malignancies (SPM), including second hematological malignancies (SHM). We evaluated the impact of SPM and SHM on progression-free survival (PFS) and OS in patients with MM after auto-HSCT using CIBMTR registry data. Adult patients with MM who underwent first auto-HSCT in the United States with melphalan conditioning regimen from 2011 to 2018 and received maintenance therapy were included (n = 3948). At a median follow-up of 37 months, 175 (4%) patients developed SPM, including 112 (64%) solid, 36 (20%) myeloid, 24 (14%) SHM, not otherwise specified, and 3 (2%) lymphoid malignancies. Multivariate analysis demonstrated that SPM and SHM were associated with an inferior PFS (hazard ratio [HR] 2.62, P < .001 and HR 5.01, P < .001, respectively) and OS (HR 3.85, P < .001 and HR 8.13, P < .001, respectively). In patients who developed SPM and SHM, MM remained the most frequent primary cause of death (42% vs 30% and 53% vs 18%, respectively). We conclude the development of SPM and SHM leads to a poor survival in patients with MM and is an important survivorship challenge. Given the median survival for MM continues to improve, continued vigilance is needed to assess the risks of SPM and SHM with maintenance therapy post–auto-HSCT.
UR - https://www.scopus.com/pages/publications/85164951515
U2 - 10.1182/bloodadvances.2022009138
DO - 10.1182/bloodadvances.2022009138
M3 - Article
C2 - 36827681
AN - SCOPUS:85164951515
SN - 2473-9529
VL - 7
SP - 2746
EP - 2757
JO - Blood Advances
JF - Blood Advances
IS - 12
ER -