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Efficacy of autologous stem cell transplantation for patients with myeloma having suboptimal response: A multicenter retrospective analysis

Autologous stem cell transplantation (ASCT) is the standard of care for myeloma patients when partial response (PR) or better is achieved after induction therapy. However, its clinical significance in patients with suboptimal response (SR), including stable disease (SD) and progressive disease (PD)...

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Published in:Transplantation and cellular therapy 2023-08
Main Authors: Suzuki, Kazuhito, Shimazu, Yutaka, Minakata, Daisuke, Ikeda, Takashi, Takahashi, Hiroyuki, Tsukada, Nobuhiro, Kanda, Yoshinobu, Doki, Noriko, Nishiwaki, Kaichi, Miwa, Akiyoshi, Sawa, Masashi, Kataoka, Keisuke, Hiramoto, Nobuhiro, Ota, Shuichi, Itagaki, Mitsuhiro, Ichinohe, Tatsuo, Atsuta, Yoshiko, Yano, Shingo, Kawamura, Koji
Format: Article
Language:English
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Summary:Autologous stem cell transplantation (ASCT) is the standard of care for myeloma patients when partial response (PR) or better is achieved after induction therapy. However, its clinical significance in patients with suboptimal response (SR), including stable disease (SD) and progressive disease (PD) before ASCT, has not been established. Additionally, functional high-risk (FHR), including RS and early PD within 12 months, was a poor prognostic factor up to now. This study aimed to evaluate the efficacy of ASCT in myeloma patients having SR in novel agent era. This multicenter, retrospective study was conducted using the Transplant Registry Unified Management Program (TRUMP) database of the Japanese Society of Transplantation and Cellular Therapy (JSTCT) and included 3898 patients with transplant-eligible patients with newly diagnosed multiple myeloma who underwent ASCT between 2007 and 2020 and were followed up until 2021. The SR rate was 4.7% including 1.7% of PD. In survival time analysis for overall cases, The significant difference of PFS between the VGPR and PR groups were observed while there was no significant difference of OS between the VGPR and PR groups. Additionally, there was no significant difference of OS and PFS between the PR and SD groups. Therefore, we focused on the PR, SD, and PD groups as the purpose of this retrospective study was to investigate the clinical significance of ASCT in patients with SR compared with those with PR. The median age of the patients was 60 years (range, 30-77 years). In total, 1605 (97.4%), 561 (38.2%), and 512 (34.9%) patients received bortezomib, immunomodulatory drug (IMiD), and both bortezomib and IMiD, respectively. A total of 558 (38.0%) patients received reinduction therapy. There were 229 (37.7 %) patients with high-risk cytogenetic risk (HRCA). In a median follow-up period of 31.7 months, a significant difference was observed in 30-month overall survival (OS) rates between the PR, SD, and PD groups (86.3%, 78.5%, and 39.4%, respectively; p
ISSN:2666-6367
DOI:10.1016/j.jtct.2023.08.006