Long-term survival of 1338 MM patients treated with tandem autologous vs. autologous-allogeneic transplantation

• Published in: Bone marrow transplantation (Basingstoke) Vol. 55; no. 9; pp. 1810 - 1816
• Main Authors: Costa, Luciano J., Iacobelli, Simona, Pasquini, Marcelo C., Modi, Riddhi, Giaccone, Luisa, Blade, Joan, Schonland, Stefan, Evangelista, Andrea, Perez-Simon, Jose A., Hari, Parameswaran, Brown, Elizabeth E., Giralt, Sergio A., Patriarca, Francesca, Stadtmauer, Edward A., Rosinol, Laura, Krishnan, Amrita Y., Gahrton, Gösta, Bruno, Benedetto
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.09.2020; Nature Publishing Group
• Subjects: 692/308/2779/109/1942; 692/699/67/1059/2325; 692/699/67/1990/804; Autografts; Care and treatment; Cell Biology; Clinical trials; Disease-Free Survival; Graft vs Host Disease; Health risks; Hematology; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Histocompatibility antigen HLA; Humans; Induction therapy; Internal Medicine; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Multiple myeloma; Myeloma; Neoplasm Recurrence, Local; Patient outcomes; Public Health; Risk assessment; Stem cell transplantation; Stem Cells; Survival; Toxicity; Transplantation; Transplantation Conditioning; Transplantation, Autologous; Transplantation, Homologous; Transplants & implants; United States
• ISSN: 0268-3369; 1476-5365; 1476-5365
• DOI: 10.1038/s41409-020-0887-4

Contrary to tandem autologous transplant (auto-auto), autologous followed by reduced intensity conditioning allogenic transplantation (auto-allo) offers graft-versus-myeloma (GVM) effect but with higher toxicity. Trials comparing these two strategies relied on availability of HLA-matched sibling donors for arm allocation (biological randomization) and yielded conflicting results. A pooled analysis of multiple trials with extended follow up provides an opportunity to compare these strategies. We obtained individual patient data from participants of four trials comparing auto-auto vs. auto-allo after induction therapy. There were 899 patients in auto-auto and 439 in auto-allo. Median follow up of survivors was 118.5 months. Median overall survival (OS) was 78.0 months in auto-auto and 98.3 months in auto-allo (HR = 0.84, P  = 0.02). OS was 36.4% vs. 44.1% at 10 years ( P  = 0.01) for auto-auto and auto-allo, respectively. Progression-free survival was also improved in auto-allo (HR = 0.84, P  = 0.004). Risk of non-relapse mortality was higher in auto-allo (10 year 8.3% vs. 19.7%, P  < 0.001), while risk of disease progression was higher in auto-auto (10 year 77.2% vs. 61.6%, P  < 0.001). Median post relapse survival was 41.5 months in auto-auto and 62.3 months in auto-allo (HR = 0.71, P  < 0.001). This supports the existence of durable GVM effect enhancing myeloma control with subsequent therapies.