Impact of second primary malignancy post–autologous transplantation on outcomes of multiple myeloma: a CIBMTR analysis
Abstract
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.
Document Details
- Document Type
- Pub Defense Publication
- Publication Date
- Jun 15, 2023
- Source ID
- 10.1182/bloodadvances.2022009138
Entities
People
- Aimaz Afrough
- Anita D'Souza
- Attaphol Pawarode
- Ayman Saad
- Baldeep Wirk
- Bhagirathbhai R. Dholaria
- Brittany Knick Ragon
- Christopher Strouse
- Cindy H. Lee
- David H. Vesole
- Gemlyn George
- Gerhard C Hildebrandt
- Gurbakhash Kaur
- Hemant S. Murthy
- Hira Mian
- Kevin C Miller
- Larry D Anderson
- Lazaros J. Lekakis
- Leona A. Holmberg
- Lohith Gowda
- Mahmoud Aljurf
- Marcos de Lima
- Melhem Solh
- Minoo Battiwalla
- Mithun V Shah
- Mohamed A Kharfan-Dabaja
- Muhammad Bilal Abid
- Muzaffar H. Qazilbash
- Navneet S Majhail
- Nina Shah
- Noel Estrada-merly
- Pashna N Munshi
- Rahul Banerjee
- Saad Z. Usmani
- Sagar Patel
- Samer Al Hadidi
- Shahrukh K Hashmi
- Shaji K Kumar
- Sherif M Badawy
- Taiga Nishihori
- Usama Gergis
- Yago Nieto
Organizations
- Ann & Robert H. Lurie Children's Hospital of Chicago
- AstraZeneca
- Fred Hutchinson Cancer Center
- H. Lee Moffitt Cancer Center & Research Institute
- Hackensack Meridian School of Medicine
- Mayo Clinic
- Medical College of Wisconsin
- Northwestern University
- Ohio State University
- Pennsylvania State University
- Thomas Jefferson University
- University of Iowa
- University of Miami
- University of Michigan
- University of Missouri
- University of South Florida
- University of Texas at Austin
- University of Utah
- University of Washington
- Vanderbilt University Medical Center
- Yale University