Allogeneic hematopoietic stem cell transplantation in patients with therapy‐related hematologic malignancies developing after multiple myeloma

• Published in: European journal of haematology 2022-05, Vol.108 (5), p.430-436
• Main Authors: Vasudevan Nampoothiri, Ram, Pasic, Ivan, Law, Arjun Datt, Lam, Wilson, Chen, Carol, Michelis, Fotios V., Kim, Dennis (Dong Hwan), Gerbitz, Armin, Lipton, Jeffrey Howard, Kumar, Rajat, Mattsson, Jonas, Viswabandya, Auro
• Format: Article
• Language: English
• Subjects: Chromosome 5; Chromosome deletion; Chronic myelomonocytic leukemia; Cytogenetics; Female; Graft vs Host Disease; Hematologic Neoplasms - diagnosis; Hematologic Neoplasms - etiology; Hematologic Neoplasms - therapy; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Hematopoietic stem cells; Histocompatibility antigen HLA; Humans; Karyotypes; Leukemia, Myeloid, Acute - therapy; Male; Monosomy; Multiple myeloma; Multiple Myeloma - diagnosis; Multiple Myeloma - etiology; Multiple Myeloma - therapy; Multivariate analysis; Neoplasm Recurrence, Local; Neoplasms, Second Primary; Patients; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma; Retrospective Studies; Statistical analysis; Stem cell transplantation; Therapy‐related hematological malignancies after multiple myeloma; Transplantation Conditioning - adverse effects; Transplantation Conditioning - methods
• ISSN: 0902-4441; 1600-0609
• DOI: 10.1111/ejh.13750

Introduction Increasing survival of patients with multiple myeloma (MM) has resulted in an increased recognition of therapy‐related hematological malignancies (t‐MDS/AML, t‐ALL, and t‐CMML). There are limited data on the role of allogeneic hematopoietic stem cell transplantation (HCT) in this patient population. Patients and Methods We retrospectively reviewed patients who underwent HCT for t‐MDS/AML, t‐ALL, and t‐CMML developing after receiving treatment for MM at our center. Patients were analyzed for myeloma characteristics and therapy, time to diagnosis of therapy‐related hematological neoplasms, clinical, laboratory characteristics, transplant details, relapse‐free survival (RFS), and overall survival (OS). Results Twenty patients underwent HCT for therapy‐related hematological malignancies after MM (t‐MDS/AML = 13, t‐ALL = 6, t‐CMML = 1). Median(range) age at time of transplant was 62.5 (49–73) years and 70% (n = 14) were male. The most common cytogenetic abnormality was complex/monosomal karyotype in 30% (n = 6) followed by monosomy/deletion of chromosome 5 or 7 in 15% (n = 3) of patients each. Donors were human leukocyte antigen matched (10/10 or 6/6) siblings in 30% (n = 6), unrelated in 60% (n = 12) and haploidentical in 10% (n = 2) patients. Estimated 2‐year OS and RFS for the whole cohort were 53.1% and 47.2% respectively. There was a trend toward better survival in patients with t‐ALL when compared to t‐MDS/AML; however, the difference was not statistically significant. We did not find any pre‐transplant or post‐transplant factors that were predictive of survival outcomes after multivariate analysis. Conclusions Allogeneic HCT provides substantial long‐term disease‐free survival in a proportion of patients with MM‐associated therapy‐related hematological malignancies. Multicenter studies with more patients and longer follow‐up may provide additional information about factors affecting outcomes.