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oai:repisalud.isciii.es:20.500.12105/226912024-11-28T20:21:42Zcom_20.500.12105_15322com_20.500.12105_2051col_20.500.12105_16967

00925njm 22002777a 4500 dc Gagelmann, Nico author Eikema, Diderik-Jan author Koster, Linda author Caillot, Denis author Pioltelli, Pietro author Bargay Lleonart, Joan author Remenyi, Peter author Blaise, Didier author Schaap, Nicolaas author Trneny, Marek author Passweg, Jakob author Parody Porras, Rocio author Cahn, Jean Yves author Musso, Maurizio author Poire, Xavier author Fenk, Roland author Itala-Remes, Maija author Pavone, Vincenzo author Fouillard, Loic author Maertens, Johan author Bron, Dominique author Pouli, Anastasia author Schroyens, Wilfried author Schoenland, Stefan author Garderet, Laurent author Yakoub-Agha, Ibrahim author Kroeger, Nicolaus author 2019-11 Although high-dose therapy and autologous stem cell transplant combined with novel agents continues to be the hallmark of first-line treatment in newly diagnosed transplant-eligible multiple myeloma patients, the impact of tandem autologous or autologous/reduced-intensity allogeneic transplant for patients with extramedullary disease (EMD) and high-risk cytogenetics is not yet defined. Here, we analyzed clinical and cytogenetic data from 488 adult myeloma patients with EMD undergoing single autologous (n = 373), tandem autologous (n = 84), or autologous-allogeneic transplant (n = 31) between 2003 and 2015. At least 1 high-risk abnormality was present in 41% (n = 202), with del(17p) (40%) and t(4;14) (45%) the most frequent. More than 1 high-risk abnormality was found in 54%. High-risk cytogenetics showed worse 4-year overall survival (OS) and progression-free survival (PFS) of 54% and 29%, respectively, versus 78% and 49% for standard-risk cytogenetics (P < .001). Co-segregation of high-risk abnormalities did not seem to affect outcome. Regarding transplant regimen, OS and PFS were 70% and 43% for single autologous versus 83% and 52% for tandem autologous and 88% and 58% for autologous-allogeneic (P=.06 and P =.30). In multivariate analysis high-risk cytogenetics were associated with worse survival (hazard ratio [HR.], 2.00; P = .003), whereas tandem autologous significantly improved outcome versus single autologous transplant (NRs,.46 and.64; P = .02 and P = .03). Autologous allogeneic transplant did not significantly differ in outcome but appeared to improve survival, but results were limited because of small population (HR, .31). In conclusion, high-risk cytogenetics is frequently observed in newly diagnosed myeloma with EMD and significantly worsens outcome after single autologous, whereas a tandem autologous transplant strategy may overcome onset poor prognosis. Gagelmann N, Eikema DJ, Koster L, Caillot D, Pioltelli P, Bargay Lleonart J, et al. Tandem Autologous Stem Cell Transplantation Improves Outcomes in Newly Diagnosed Multiple Myeloma with Extramedullary Disease and High-Risk Cytogenetics: A Study from the Chronic Malignancies Working Party of the European Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant. 2019 Nov;25(11):2134-42. Epub 2019 Jul 6. 10.1016/j.bbmt.2019.07.004 1523-6536 1083-8791 Biology of Blood and Marrow Transplantation http://hdl.handle.net/20.500.13003/17257 31288095 L2002510511 2-s2.0-85070201442 https://hdl.handle.net/20.500.12105/22691 500077400003 Myeloma Extramedullary disease Autologous Tandem Allogeneic Cytogenetics Tandem Autologous Stem Cell Transplantation Improves Outcomes in Newly Diagnosed Multiple Myeloma with Extramedullary Disease and High-Risk Cytogenetics: A Study from the Chronic Malignancies Working Party of the European Society for Blood and Marrow Transplantation