Impact of second primary malignancy post-autologous transplantation on outcomes of multiple myeloma: a CIBMTR analysis.
Publication/Presentation Date
6-27-2023
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.
Volume
7
Issue
12
First Page
2746
Last Page
2757
ISSN
2473-9537
Published In/Presented At
Ragon, B. K., Shah, M. V., D'Souza, A., Estrada-Merly, N., Gowda, L., George, G., de Lima, M., Hashmi, S., Kharfan-Dabaja, M. A., Majhail, N. S., Banerjee, R., Saad, A., Hildebrandt, G. C., Mian, H., Abid, M. B., Battiwalla, M., Lekakis, L. J., Patel, S. S., Murthy, H. S., Nieto, Y., … Usmani, S. Z. (2023). Impact of second primary malignancy post-autologous transplantation on outcomes of multiple myeloma: a CIBMTR analysis. Blood advances, 7(12), 2746–2757. https://doi.org/10.1182/bloodadvances.2022009138
Disciplines
Medicine and Health Sciences
PubMedID
36827681
Department(s)
Department of Medicine, Lehigh Valley Topper Cancer Institute
Document Type
Article