Impact of Second Primary Malignancy Post-Autologous Transplantation on Outcomes of Multiple Myeloma: A CIBMTR Analysis

Brittany Knick Ragon; Christopher S Strouse; Mithun Vinod Shah; Anita D'Souza; Noel Estrada-Merly; Lohith Gowda; Gemlyn George; Marcos DeLima; Shahrukh Hashmi; Mohamed A Kharfan-Dabaja; Navneet S Majhail; Rahul Banerjee; Ayman Saad; Gerhard C Hildebrandt; Hira Mian; Muhammad Bilal Abid; Minoo Battiwalla; Lazaros J Lekakis; Sagar S Patel; Hemant S Murthy; Yago Nieto; Sherif M Badawy; Samer Ai Al Hadidi; Bhagirathbhai Dholaria; Mahmoud Aljurf; David H Vesole; Cindy H Lee; Attaphol Pawarode; Usama Gergis; Kevin Charles Miller; Leona A Holmberg; Aimaz Afrough; Melhem M Solh; Pashna Munshi; Taiga Nishihori; Larry D Anderson; Baldeep Wirk; Gurbakhash Kaur; Muzaffar H Qazilbash; Nina Shah; Shaji K Kumar; Saad Z Usmani

doi:10.1182/bloodadvances.2022009138

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Impact of Second Primary Malignancy Post-Autologous Transplantation on Outcomes of Multiple Myeloma: A CIBMTR Analysis

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Impact of Second Primary Malignancy Post-Autologous Transplantation on Outcomes of Multiple Myeloma: A CIBMTR Analysis

Brittany Knick Ragon, Christopher S Strouse, Mithun Vinod Shah, Anita D'Souza, Noel Estrada-Merly, Lohith Gowda, Gemlyn George, Marcos DeLima, Shahrukh Hashmi, Mohamed A Kharfan-Dabaja, …

Blood advances, Vol.7(12), pp.2746-2767

06/15/2023

DOI: 10.1182/bloodadvances.2022009138

PMCID: PMC10275699

PMID: 36827681

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Abstract

The overall survival (OS) has improved significantly in multiple myeloma (MM) over the last decade with use of proteasome inhibitor and immunomodulatory drug-based combinations, followed by high-dose melphalan and autologous hematopoietic stem cell transplantation (auto-HSCT) and subsequent maintenance therapies in eligible newly diagnosed patients. However, clinical trials employing auto-HSCT followed by lenalidomide maintenance have shown an increased risk of second primary malignancies (SPM), including second hematological malignancies (SHM). We evaluated the impact of SPM and SHM on progression-free survival (PFS) and OS in MM patients following auto-HSCT using CIBMTR registry data. Adult MM patients who underwent first auto-HSCT in the United States with melphalan conditioning regimen from 2011 to 2018 and received maintenance therapy were included (n=3,948). At a median follow up of 37 months, 175 (4%) patients developed SPM, including 112 (64%) solid, 36 (20%) myeloid, 24 (14%) SHM, not otherwise specified, and 3 (2%) lymphoid malignancies. Multivariate analysis demonstrated that SPM and SHM were associated with an inferior PFS (HR 2.62, P<.001 and HR 5.01, P<.001, respectively) and OS (HR 3.85, P<.001 and HR 8.13, P<.001, respectively). In patients who developed SPM and SHM, MM remained the most frequent primary cause of death (42% versus 30% and 53% versus 18%, respectively). We conclude the development of SPM and SHM leads to a poor survival in MM patients and is an important survivorship challenge. Given the median survival for MM continues to improve, continued vigilance is needed to assess the risks of SPM and SHM with maintenance therapy post-auto-HSCT.

Details

Title: Subtitle: Impact of Second Primary Malignancy Post-Autologous Transplantation on Outcomes of Multiple Myeloma: A CIBMTR Analysis
Creators: Brittany Knick Ragon - Levine Cancer Institute
Christopher S Strouse - University of Iowa
Mithun Vinod Shah - Mayo Clinic, Rochester, Minnesota, United States
Anita D'Souza - Medical College of Wisconsin
Noel Estrada-Merly - CIBMTR, Milwaukee, Wisconsin, United States
Lohith Gowda - Yale School of Medicine
Gemlyn George - University of Colorado Anschutz Medical Campus
Marcos DeLima - The Ohio State University
Shahrukh Hashmi - Sheikh Shakhbout Medical City
Mohamed A Kharfan-Dabaja - Mayo Clinic, Jacksonville, Florida, United States
Navneet S Majhail - Sarah Cannon
Rahul Banerjee - Fred Hutchinson Cancer Center, United States
Ayman Saad - The Ohio State University
Gerhard C Hildebrandt - University of Missouri
Hira Mian - McMaster University
Muhammad Bilal Abid - Medical College of Wisconsin
Minoo Battiwalla - Sarah Cannon Research Institute
Lazaros J Lekakis - University of Miami
Sagar S Patel - Huntsman Cancer Institute
Hemant S Murthy - Mayo Clinic
Yago Nieto - The University of Texas MD Anderson Cancer Center
Sherif M Badawy - Northwestern University
Samer Ai Al Hadidi - University of Arkansas for Medical Sciences
Bhagirathbhai Dholaria - Vanderbilt University Medical Center
Mahmoud Aljurf - King Faisal Specialist Hospital, Riyadh, Saudi Arabia
David H Vesole
Cindy H Lee - Royal Adelaide Hospital
Attaphol Pawarode - University of Michigan
Usama Gergis - Thomas Jefferson University
Kevin Charles Miller - Massachusetts General Hospital
Leona A Holmberg - Fred Hutch Cancer Center
Aimaz Afrough - The University of Texas Southwestern Medical Center
Melhem M Solh - Northside Hospital
Pashna Munshi - Georgetown University
Taiga Nishihori - Morsani College of Medicine, University South of Florida, United States
Larry D Anderson - The University of Texas Southwestern Medical Center
Baldeep Wirk - Pennsylvania State University
Gurbakhash Kaur - The University of Texas Southwestern Medical Center
Muzaffar H Qazilbash - M.D. Anderson Cancer Center, Houston, Texas, United States
Nina Shah - AstraZeneca (Switzerland)
Shaji K Kumar - Mayo Clinic, Rochester, Minnesota, United States
Saad Z Usmani - Memorial Sloan Kettering Cancer Center
Resource Type: Journal article
Publication Details: Blood advances, Vol.7(12), pp.2746-2767
DOI: 10.1182/bloodadvances.2022009138
PMID: 36827681
PMCID: PMC10275699
NLM abbreviation: Blood Adv
eISSN: 2473-9537
Language: English
Electronic publication date: 02/24/2023
Date published: 06/15/2023
Academic Unit: Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
Record Identifier: 9984368431602771

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