Trends in Autologous Transplantation for Myeloma in EBMT Centres between 1993 and 2017

• Main Authors: Hayden, Patrick J, Eikema, Dirk-Jan, Koster, Linda, Goldschmidt, Hartmut, Blaise, Didier, Potter, Michael, Touzeau, Cyrille, Huynh, Anne, Byrne, Jenny, Hulin, Cyrille, Rabin, Neil K, Benjamin, Reuben, Cornelissen, Jan J, Nahi, Hareth, Cook, Gordon, Gribben, John G., Meijer, Ellen, Reményi, Péter, Mayer, Jiri, Tsirigotis, Panagiotis, Bernardeschi, Paolo, Beksac, Meral, Schönland, Stefan O., Yakoub-Agha, Ibrahim
• Format: Conference Proceeding
• Language: English
• Subjects: Medicin och hälsovetenskap
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2019-127166

Introduction The use of autologous haematopoietic cell transplantation (auto-HCT) in the treatment of myeloma (MM) has greatly increased over the last twenty-five years. There are, however, few large datasets detailing the overall trends in transplant use, patient selection, induction regimen, choice of mobilisation regimen, stem cell yield, response to transplant and survival. We performed a retrospective analysis of all patients who underwent first auto-HCT for MM in EBMT centres between 1993 and 2017 and analysed these trends over consecutive five-year cohorts: (1) 1993-1997, (2) 1998-2002, (3) 2003-2007, (4) 2008-2012 and (5) 2013-2017. Methods Data on patients with MM who underwent a first auto-HCT at EBMT centres between 1993 and 2017 were obtained from the EBMT registry. Med-A forms consist of registration and follow-up forms. More detailed information in captured in Med-B forms. Results A total of 103,032 patients in 568 centres in 54 countries were included in this analysis. The number of transplants increased seven-fold between the first and fifth cohorts: (1) 5,246, (2) 12,554, (3) 21,153, (4) 28,390 and (5) 35,689. The gender breakdown has been consistent over time: 58% Male, 42% Female. Over these years, the median patient age at transplant has increased significantly, as follows: (1) 54, (2) 57, (3) 58, (4) 59, and (5) 61 years. The percentage of patients >65 years at transplant has also increased: (1) 3%, (2) 9%, (3) 14%, (4) 14%, and (5) 22%. Between 1993 and 1997, IgG, IgA and Light Chain (LC) MM constituted 58%, 22% and 16%, respectively. The corresponding percentages between 2013 and 2017 were 52%, 18% and 27%, respectively. Data on the choice of first induction regimen was available in 19,882 (21%) cases (Med-B forms) though only cohorts 4 (2008-2012) and 5 (2013-2017) had specific data in more than 80% of cases. The trends in the percentage use of these regimens in the two cohorts since 2008 are as follows: VTD: 11% to 32%; VCD: 5% to 20%; CTD 15% to 10%; VD: 19% to 7%; PAD 5% to 4%; VRD 2% to 3%; VAD: 8% to 3%. The CR rates pre-ASCT have improved: (1) 16% (2) 14% (3) 13% (4) 20% and (5) 21%; >PR rates pre-ASCT also reveal deeper responses over time: (1) 65%, (2) 68%, (3) 70%, (4) 72%, and (5) 73%. Stem cell mobilisation regimen data was available in 19,882 (19%) cases. In these centres, the use of cyclophosphamide has steadily increased: (1) 31%, (2) 54%, (3) 63%, (4) 64%, and (5) 65%. Conversely, the use of single agent G-CSF has dec