J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 5, Number 3, June 2013, pages 174-184

Outcomes of Salvage Autologous Versus Allogeneic Hematopoietic Cell Transplantation for Relapsed Multiple Myeloma After Initial Autologous Hematopoietic Cell Transplantation

**Table 1.** Patient Characteristics
Variable	AutoHCT2 N = 27	AlloHCT2 N = 19
* statistically significant.
Male/Female	16/11	10/9
Median age years (range)*	62 (32 - 69)	54 (43 - 63)
Median months from diagnosis to autoHCT1	8 (3 - 39)	8 (5 - 30)
KPS at HCT2: ≥ 70% vs. <70% *	20/7	19/0
HCT comorbidity index
0, 1	5	8
2, 3	10	7
> 3	12	4
Durie-Salmon stage :I/II/III/unknown	4/6/17	0/5/13/1
ISS stage: I/II/III/unknown	11/4/5/7	9/5/3/2
B2microglobulin at HCT2: ≥ 3.5/<3.5/unknown	9/14/4	4/14/1
Cytogenetics
High risk/intermediate	9	4
Standard risk	15	13
Unknown	3	2
IG subtype
IgG	12	10
IgA	7	8
Light chain	8	0
Nonsecretory		1
Lines of chemo before HCT2	1 (1 - 5)	2 (1 - 5)
Chemosensitive before HCT2:Yes/No	11/16	11/8
Induction before HCT2*
Conventional chemo	6	12
Novel agents	21	7
Time from autoHCT1 to relapse: months (range)	16.5 (4 - 42)	12 (2 - 45)
Time from autoHCT1 to HCT2 months (range)	30 (5 - 104)	21 (7 - 91)
conditioning for autoHCT1	2/7/18	1/12/6
BuCY/BuCyVP16/melphalan
Conditioning for alloHCT2: Reduced intensity (FLU/BU N = 12, FLU/MEL N = 3, FLU/CY/TBI N = 1), Myeloablative (BU/CY N = 3)	Reduced intensity conditioning 16
Myeloablative 3
Conditioning for autoHCT2	9/2/16
BuCy/ BuCyVP16/melphalan
Donor type
Matched sibling related 6/6		13
Matched unrelated 10/10		5
Haploidentical related 7/14	1
Stem cell type BM/PB	0/27	1/18
Year of HCT2*
1995 - 2005	6	8
2006 - 2011	21	11
Disease status before/after HCT2
CR	0/4	2/3
VGPR	2/11	3/4
PR	9/7	6/4
SD	1/2	8/0
PD	15/3	0/8
Maintenance after HCT2: yes vs. no	12/15	3/16
Median months of follow up from diagnosis (range)	57 (19 - 115)	57 (22 - 154)

Table 1. Patient Characteristics

Variable

AutoHCT2
N = 27

AlloHCT2
N = 19

* statistically significant.

Male/Female

16/11

10/9

Median age years (range)*

62 (32 - 69)

54 (43 - 63)

Median months from diagnosis to autoHCT1

8 (3 - 39)

8 (5 - 30)

KPS at HCT2: ≥ 70% vs. <70% *

20/7

19/0

HCT comorbidity index

0, 1

2, 3

> 3

Durie-Salmon stage :I/II/III/unknown

4/6/17

0/5/13/1

ISS stage: I/II/III/unknown

11/4/5/7

9/5/3/2

B2microglobulin at HCT2: ≥ 3.5/<3.5/unknown

9/14/4

4/14/1

Cytogenetics

High risk/intermediate

Standard risk

Unknown

IG subtype

IgG

IgA

Light chain

Nonsecretory

Lines of chemo before HCT2

1 (1 - 5)

2 (1 - 5)

Chemosensitive before HCT2:Yes/No

11/16

11/8

Induction before HCT2*

Conventional chemo

Novel agents

Time from autoHCT1 to relapse: months (range)

16.5 (4 - 42)

12 (2 - 45)

Time from autoHCT1 to HCT2 months (range)

30 (5 - 104)

21 (7 - 91)

conditioning for autoHCT1

2/7/18

1/12/6

BuCY/BuCyVP16/melphalan

Conditioning for alloHCT2: Reduced intensity (FLU/BU N = 12, FLU/MEL N = 3, FLU/CY/TBI N = 1), Myeloablative (BU/CY N = 3)

Reduced intensity conditioning 16

Myeloablative 3

Conditioning for autoHCT2

9/2/16

BuCy/ BuCyVP16/melphalan

Donor type

Matched sibling related 6/6

Matched unrelated 10/10

Haploidentical related 7/14

Stem cell type BM/PB

0/27

1/18

Year of HCT2*

1995 - 2005

2006 - 2011

Disease status before/after HCT2

0/4

2/3

VGPR

2/11

3/4

9/7

6/4

1/2

8/0

15/3

0/8

Maintenance after HCT2: yes vs. no

12/15

3/16

Median months of follow up from diagnosis (range)

57 (19 - 115)

57 (22 - 154)

**Table 2.** AlloHCT2 Patient Characteristics
Variable	Allohct2 N = 19
Donor/recipient gender
M/M	6
M/F	8
F/F	2
F/M	3
Conditioning for alloHCT2
Reduced intensity conditioning
FLU/BU	12
FLU/MEL	3
FLU/CY/TBI	1
Myeloablative BU/CY	3
GVHD prophylaxis
FK	11
FK/MTX	7
CSA/MMF	1
DLI use, yes/no	10/9
ATG use, yes/no	15/4
Acute GVHD
None	6
I-II	6
III-IV	7
Chronic GVHD
None	12
Limited	2
Extensive	5
Causes of death
PD	5
GVHD	3
Infection	3
Renal failure	1

Table 2. AlloHCT2 Patient Characteristics

Variable

Allohct2 N = 19

Donor/recipient gender

M/M

M/F

F/F

F/M

Conditioning for alloHCT2

Reduced intensity conditioning

FLU/BU

FLU/MEL

FLU/CY/TBI

Myeloablative BU/CY

GVHD prophylaxis

FK/MTX

CSA/MMF

DLI use, yes/no

10/9

ATG use, yes/no

15/4

Acute GVHD

None

I-II

III-IV

Chronic GVHD

None

Limited

Extensive

Causes of death

GVHD

Infection

Renal failure

**Table 3.** Studies on Salvage Autohct2 Versus Salvage Allohct2 After Relapse From Initial Autohct1
Variable	Qazilbash et al	This study
Year inclusive	1992 - 2006	1995 - 2011
# of patients autoHCT2/alloHCT2	14/26	27/19
Time from AutoHCT1 and AutoHCT2 (months)	25	30
Time from AutoHCT1 to AlloHCT2 (months)	17	21
Disease response post autoHCT2, CR/VGPR/PR	21%/-/43%	15%/41%/26%
Disease response post alloHCT2, CR/VGPR/PR	31%/-/38%	16%/21%/21%
NRM after autoHCT2/alloHCT2	7%/11%	3.7%/5.3%
Median PFS post autoHCT2/alloHCT2 (months)	6.8/7.3	19/6
Median OS post autoHCT2/alloHCT2 (months)	29.5/13	23/19
Prognostic Factors	Univariate analysis: time from autoHCT1 to alloHCT2 > 1 year (P = 0.02) predicted significantly better OS for alloHCT2 No factors impacted OS in autoHCT2 group	Multivariate analysis: relapse from autoHCT1 ≥ 1 year favorably impacted PFS and OS after autoHCT2. Also, maintenance therapy after autoHCT2 favorably impacted OS after autoHCT2. No factors impacted PFS/OS after alloHCT2.

Table 3. Studies on Salvage Autohct2 Versus Salvage Allohct2 After Relapse From Initial Autohct1

Variable

Qazilbash et al

This study

Year inclusive

1992 - 2006

1995 - 2011

# of patients autoHCT2/alloHCT2

14/26

27/19

Time from AutoHCT1 and AutoHCT2 (months)

Time from AutoHCT1 to AlloHCT2 (months)

Disease response post autoHCT2, CR/VGPR/PR

21%/-/43%

15%/41%/26%

Disease response post alloHCT2, CR/VGPR/PR

31%/-/38%

16%/21%/21%

NRM after autoHCT2/alloHCT2

7%/11%

3.7%/5.3%

Median PFS post autoHCT2/alloHCT2 (months)

6.8/7.3

19/6

Median OS post autoHCT2/alloHCT2 (months)

29.5/13

23/19

Prognostic Factors

Univariate analysis: time from autoHCT1 to alloHCT2 > 1 year (P = 0.02) predicted significantly better OS for alloHCT2
No factors impacted OS in autoHCT2 group

Multivariate analysis: relapse from autoHCT1 ≥ 1 year favorably impacted PFS and OS after autoHCT2. Also, maintenance therapy after autoHCT2 favorably impacted OS after autoHCT2. No factors impacted PFS/OS after alloHCT2.