Early relapse after autologous hematopoietic cell transplantation remains a poor prognostic factor in multiple myeloma but outcomes have improved over time

Abstract

Duration of initial disease response remains a strong prognostic factor in multiple myeloma (MM) particularly for upfront autologous hematopoietic cell transplant (AHCT) recipients. We hypothesized that new drug classes and combinations employed prior to AHCT as well as after post-AHCT relapse may have changed the natural history of MM in this population. We analyzed the Center for International Blood and Marrow Transplant Research database to track overall survival (OS) of MM patients receiving single AHCT within 12 months after diagnosis (N=3256) and relapsing early post-AHCT (<24 months), and to identify factors predicting for early vs late relapses (24-48 months post-AHCT). Over three periods (2001-2004, 2005-2008, 2009-2013), patient characteristics were balanced except for lower proportion of Stage III, higher likelihood of one induction therapy with novel triplets and higher rates of planned post-AHCT maintenance over time. The proportion of patients relapsing early was stable over time at 35-38%. Factors reducing risk of early relapse included lower stage, chemosensitivity, transplant after 2008 and post-AHCT maintenance. Shorter post-relapse OS was associated with early relapse, IgA MM, Karnofsky <90, stage III, >1 line of induction and lack of maintenance. Post-AHCT early relapse remains a poor prognostic factor, even though outcomes have improved over time.

Figure 1

Panel A: Progression free survival from AHCT for the three groups of patients by the date of AHCT (2001-204, 2005–2008, 2009–2013). Panel B: Overall survival from AHCT for the three groups of patients by the date of AHCT (2001-204, 2005–2008, 2009–2013) Panel C: Trends in the proportion of patients with early relapse

Figure 2

Panel A: Overall survival from diagnosis among patients with early relapse (< 24 months) and late relapse (>24 months) Panel B: Post-relapse survival for early relapse patients (relapse within 24 months) compared to those with a late relapse Panel C: Post-relapse survival for early relapse patients who relapsed within 24 months grouped by relapse year 2005 Panel D: Post-relapse survival for early relapse patients who relapsed within 24 months, grouped by the date of AHCT (2001-204, 2005–2008, 2009–2013)