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. 2025 Mar;104(3):1735-1745.
doi: 10.1007/s00277-025-06262-9. Epub 2025 Feb 26.

Is there still a place for autologous salvage transplantation in relapsed/refractory multiple myeloma in the era of novel therapies?

Simone Karp  1   2 , Karolin Trautmann-Grill  3 , Paul Warncke  1   2 , Dominik Zolnowski  1   2 , Christoph Röllig  3 , Marcel Pannach  1 , Jessica Zinn  1 , Frank Kroschinsky  3 , Anke Morgner  1   2 , Malte von Bonin  3 , Annette Hänel  1 , Regina Herbst  1   2 , Stephan Fricke  1   2 , Martin Bornhäuser  3 , Mathias Hänel  4   5 , Raphael Teipel  3
Affiliations

Is there still a place for autologous salvage transplantation in relapsed/refractory multiple myeloma in the era of novel therapies?

Simone Karp et al. Ann Hematol. 2025 Mar.

Abstract

For patients (pts) with relapsed or refractory multiple myeloma (RRMM) after previous autologous hematopoietic cell transplantation (AHCT), novel agents, cellular and immunotherapies are increasingly available. Options for second-line treatment mostly include triplet regimens based on proteasome inhibitors, immunomodulatory drugs and anti-CD38 monoclonal antibodies and since recently also CAR T cells. The importance of autologous salvage transplantation (retransplantation, Re-AHCT) has significantly decreased in recent years due to the availability of many new treatment options. Therefore, we performed a retrospective analysis of 171 pts cases with RRMM who received Re-AHCT between 2002 and 2021. With a median follow-up of 74.7 months, the 5-year rates of progression-free survival (PFS) and overall survival (OS) were 18% (median 20.6 months) and 57% (median 65.0 months), respectively, the 100-day mortality rate was 4%. Multivariate analysis identified R-ISS stage and duration of previous response (DoR) as independent prognostic factors for PFS and OS. While the revealed high-risk population (R-ISS stage II/III, DoR ≤ 24 months) was associated with a significantly worse PFS (HR 2.728) and OS (HR 3.129), the low-risk group (R-ISS I, DoR > 24 months) achieved a median PFS and OS of 45.0 months and 80.2 months, respectively. Therefore, Re-AHCT could remain an option in such prognostically favorable pts with RRMM even in the era of novel therapies especially when more potent treatment modalities are not available.

Keywords: Autologous hematopoetic cell transplantation; Multiple myeloma; Relapse; Retransplantation; Salvage autologous.

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Conflict of interest statement

Declarations. Ethical approval: The study was approved by the regional ethics committees of the State Chamber of Physicians of Saxony (EK-BR-40/23 − 1). Patient consent: Patient consent was waived in accordance with the ethical approval due to retrospective design of the analysis and anonymization. Competing interests: K. Trautmann-Grill has received consultation fees and/or honoraria from Sanofi, Takeda, Novartis, Amgen, GSK, Janssen; travel grants from Janssen, NovoNordisk, GSK, Sanofi and has participated in Data Safety Monitoring Board or advisory boards for Sanofi, Novartis, Amgen, GSK. M. Hänel has received consultations fees and/or honoraria from Novartis, Amgen, GSK, Celgene, Sanofi-Aventis, Janssen, and Bristol-Myers Squibb. R. Herbst has received honoraria from Novartis, Bristol-Myers Squibb and Amgen. R. Teipel has participated in advisory boards or has received honoraria from Janssen, Bristol-Myers Squibb, Takeda, GSK, Gilead, Sanofi, Amgen, Stemline, Oncopeptides and Abbvie as well as research and travel grants from Janssen. All other authors declare no competing financial interests in relation to the work described. All authors declare that potential competing interests did not influence the content and results of the manuscript.

Figures

Fig. 1
Fig. 1
Progression-free survival (a) and overall survival (b) for 171 patient cases after Re-AHCT
Fig. 2
Fig. 2
Progression-free survival (a) and overall survival (b) by risk groups. Low risk (LR), intermediate risk (IR) and high risk (HR) based on R-ISS and duration of response for 167 patient cases
See this image and copyright information in PMC

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