Trends in utilization and outcomes of autologous transplantation as early therapy for multiple myeloma

Abstract

The impact of novel drugs for treating multiple myeloma (MM) on the utilization and outcomes of autologous hematopoietic progenitor cell transplantation (AHPCT) is unknown. We reviewed characteristics and outcomes of 20,278 patients who underwent AHPCT within 12 months of diagnosis of MM in the United States and Canada and registered at the Center for International Blood and Marrow Transplant Research (CIBMTR) in 3 time cohorts reflecting the increasing availability of novel drugs: 1995 to 1999 (n = 2226), 2000 to 2004 (n = 6408), and 2005 to 2010 (n = 11,644). In the United States, the number of AHPCTs performed increased at a greater rate than new MM cases. Patients in recent cohorts were older, less likely to have stage 3 MM, and more likely to have received previous thalidomide, lenalidomide, or bortezomib. On multivariate analysis, AHPCT in the 2000 to 2004 cohort (HR = 0.77) or in the 2005 to 2010 cohort (HR = 0.68) were associated with lower risk of death. Survival at 60 months post-AHPCT improved from 47% in 1995 to 1999 to 55% in 2000 to 2004 and to 57% in 2005 to 2010, owing less to improvement in progression-free survival (50% versus 55% versus 57% at 24 months) than to postrelapse/progression survival (58% versus 65% versus 72% at 24 months). AHPCT and new biological agents are complementary, nonredundant therapies and should be combined in the management of MM in suitable patients.

Keywords: Autologous stem cell transplantation; Multiple myeloma; Population study; Survival.

Figure 1

Changes in the estimated number of patients who underwent first AHPCT for the treatment of MM over the years and for different age groups (error bars= +/− 10%). The sharp increase in AHPCT is in contrast with the much slower rate of increase in the number of newly diagnosed MM patients (error bars = 95% confidence interval).

Figure 2

Outcomes of patients undergoing early (< 12 months) AHPCT for MM in three different time cohorts. Panel a represents all patients registered (TED dataset), while the similar panel b display survival for patients reported with more detailed information (CRF dataset). Panel c displays progression free survival after transplantation while panel d displays overall survival after relapse/progression for patients included in the CRF dataset. Comparisons between cohorts is displayed in Table 3.

Figure 3

Overall survival of patients (from the TED dataset) undergoing early (<12 months) AHPCT for MM in three different time cohorts and stratified by age group: < 50 years (panel a); 50–64 years (panel b) and ≥ 65 years (panel c). P=0.007 for the independent effect of age and era.