2021 EBMT | ASCT sequential allo-HSCT followed by maintenance treatment can improve the efficacy of MM patients?

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is still controversial in the treatment of multiple myeloma (MM).

Nicolaus Kröger and others in Germany conducted a study comparing autologous hematopoietic stem cell transplantation (ASCT) sequential allo-HSCT (auto-allo TSCT) followed by maintenance therapy, and ASCT sequential ASCT (auto-auto TSCT) followed In order to maintain the efficacy of treatment in newly diagnosed MM patients, the results of the study will be announced at the 47th European Association of Blood and Bone Marrow Transplantation (EBMT 2021) in 2021.

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The research method was conducted between 2008 and 2014.
This open-label, multi-center clinical study included 210 MM patients (age <60 years) from 23 centers in Germany to explore the combination of auto-allo TSCT + 2-year maintenance treatment (Shah Compared with Lidomide, 100mg/d), whether auto-auto TSCT + 2-year maintenance treatment (thalidomide, 100mg/d) can improve the progression-free survival (PFS).

When there is a matching related or unrelated donor, the patient will receive auto-allo TSCT in peripheral blood, and if the patient refuses allo-HSCT, he will receive auto-auto TSCT.

The main study endpoint is PFS 4 years after sequential transplantation.

A total of 178 patients received a second transplant (132 in the auto-allo TSCT group and 46 in the auto-auto TSCT group).

The median age is 51 years (range: 26-61 years) (Figure 1).

Figure 1 The results of the study are shown in Table 1: Table 1 auto-allo TSCT group vs auto-auto TSCT group: the 4-year cumulative non-recurring death (NRM) rate was 12.
9% (CI: 8-20%) and 2.
2% (CI) : 0.
3-2), p=0.
04 (Table 2; Figure 2); the cumulative incidence of recurrence/progression in 4 years was 40.
2% (CI: 33-50%) and 62.
9% (CI: 50-79%), p =0.
01 (Figure 2); 4-year PFS rates were 46.
9% (CI: 38-55%) and 35% (CI: 21-49%), median PFS were 40.
1 and 29.
8 months, p=0.
26( Figure 2); the 4-year OS rate was 65.
8% (CI: 57-73%) and 65.
7% (CI: 50-78%), p=0.
906 (Figure 2).

Table 2 Figure 2 After Allo-HSCT or donor lymphocyte infusion (DLI), the incidence of any grade of acute and chronic graft-versus-host disease (GVHD) is 55% and 61%, respectively.

Conclusions In this prospective phase II study, compared with auto-auto TSCT, auto-allo TSCT reduced the recurrence or progression rate of MM by approximately 1/3 during the 4-year follow-up (from 62.
9% to 40.
2 %).

At the same time, auto-allo TSCT also reduced disease-related mortality by about 1/3 (from 30.
4% to 21.
2%).

However, patients who received auto-allo TSCT had a higher NRM rate, and the advantage of auto-allo TSCT in PFS did not reach statistical significance.

Reference source: N.
Kröger, U.
Hegenbart, M.
Stelljes, et al.
AUTOLOGOUS-ALLOGENEIC VS AUTOLOGOUS TANDEM STEM CELL TRANSPLANTATION AND MAINTENANCE WITH THALIDOMIDE FOR PATIENTS WITH MULTIPLE MYELOMA (MM) AND AGE <60 YEARS: A PROSPECTIVE PHASE II- STUDY.
The 47th Annual Meeting of the EBMT.
Abstract OS21-4.
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