Trends in Outcomes After Upfront Autologous Transplant for Multiple Myeloma Over Three Decades

• Published in: Transplantation and cellular therapy 2024-08, Vol.30 (8), p.772.e1-772.e11
• Main Authors: Pasvolsky, Oren, Marcoux, Curtis, Dai, Jianliang, Milton, Denái R., Tanner, Mark R., Syed, Naureen, Bashir, Qaiser, Srour, Samer, Saini, Neeraj, Lin, Paul, Ramdial, Jeremy, Nieto, Yago, Tang, Guilin, Aljawai, Yosra, Lee, Hans C., Gaballa, Mahmoud R, Patel, Krina K., Kebriaei, Partow, Thomas, Sheeba K., Orlowski, Robert Z., Shpall, Elizabeth J., Champlin, Richard E., Qazilbash, Muzaffar H.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Autologous; Female; Hematopoietic Stem Cell Transplantation; Humans; Male; Middle Aged; Multiple myeloma; Multiple Myeloma - mortality; Multiple Myeloma - therapy; Retrospective Studies; Transplantation; Transplantation, Autologous - statistics & numerical data; Treatment Outcome
• ISSN: 2666-6367; 2666-6367
• DOI: 10.1016/j.jtct.2024.06.001

•Retrospective study of NDMM patient outcomes following auto-SCT from 1988-2021.•Average age and comorbidity burden of transplanted patients increased over time.•Outcomes improved following auto-SCT in NDMM patients over the last three decades, including those with high-risk disease.•Median PFS improved from 22.3 months between 1988-2000 to 58.6 months in 2016-2021.•Median OS improved from 55.1 months between 1988-2000 to not reached in 2016-2021. Upfront autologous stem cell transplantation (auto-SCT) remains standard of care for eligible patients with newly diagnosed multiple myeloma (NDMM), although recently its role has been questioned. The aim of the study was to evaluate trends in patient characteristics, treatment, and outcomes of NDMM who underwent upfront auto-SCT over three decades. We conducted a single-center retrospective analysis of patients with NDMM who underwent upfront auto-SCT at MD Anderson Cancer Center between 1988 to 2021. Primary end points were progression-free survival (PFS) and overall survival (OS). Patients were grouped by the year of auto-SCT: 1988-2000 (n = 249), 2001-2005 (n = 373), 2006-2010 (n = 568), 2011-2015 (n = 815) and 2016-2021 (n = 1036). High-risk cytogenetic abnormalities were defined as del (17p), t (4;14), t (14;16), and 1q21 gain or amplification by fluorescence in situ hybridization. We included 3041 MM patients in the analysis. Median age at auto-SCT increased from 52 years (1988-2000) to 62 years (2016-2021), as did the incidence of high-risk cytogenetics from 15% to 40% (P < .001). Comorbidity burden, as measured by a Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) of >3, increased from 17% (1988-2000) to 28% (2016-2021) (P < .001). Induction regimens evolved from predominantly chemotherapy to immunomodulatory drug (IMiD) and proteasome inhibitor (PI) based regimens, with 74% of patients receiving IMiD-PI triplets in 2016-2021 (39% bortezomib, lenalidomide and dexamethasone (VRD) and 35% carfilzomib, lenalidomide and dexamethasone [KRD]). Response rates prior to auto-SCT steadily increased, with 4% and 10% achieving a ≥CR and ≥VGPR compared to 19% and 65% between 1988-2000 and 2016-2021, respectively. Day 100 response rates post auto-SCT improved from 24% and 49% achieving ≥CR and ≥VGPR between 1988-2000 to 41% and 81% between 2016-2021, respectively. Median PFS improved from 22.3 months between 1988-2000 to 58.6 months between 2016-2021 (HR 0.42, P < .001). Among patients with high-