Table 5 Selected studies using salvage ASCT or Allo-SCT in the treatment of relapsed/refractory multiple myeloma

From: Evolving paradigms in the treatment of relapsed/refractory multiple myeloma: increased options and increased complexity

Clinical study

N

Efficacy post-ASCT2

Post-ASCT2 TRM incidence

ASCT

 Cook G et al.59

106 case-matched pairsa,b,c (ASCT2 vs conventional chemotherapy)

ORR: 64%

4-year OS rate: 32% vs 22% (P<0.001)

Within 100 days: 7%

1 year: 7%

5 years: 12%

 Gonsalves WI et al.60

98a,b

(ASCT2 after ASCT1 performed between 1994 and 2009)

ORR: 86%

Median PFS: 10.3 months

Median OS: 33 months

4%

 Jimenez-Zepeda et al.61

81a,b

(ASCT2 performed between 1992 and 2009)

ORR, day 100: 97%

Median PFS: 16.4 months

Median OS: 53 months

Within 100 days: 2.6%

 Lemieux E et al.62

81b,d

(HDT + ASCT2 performed between 1995 and 2009 after frontline or tandem ASCT)

ORR: 93%

Median PFS: 18 months

Median OS: 4 years

0

 Michaelis LC et al.63

187a,b,c

(ASCT2 performed between 1995 and 2008)

1-, 3- and 5-year respective PFS rates: 47, 13 and 5%

1-, 3- and 5-year respective OS rates: 83, 46 and 29%

1 year: 2%

3 years: 4%

 Morris C et al.64

7452b,c,e

(ASCT2 after ASCT1 performed between 1993 and 2002)

n=2655 (planned ASCT2)

n=4797 (unplanned ASCT2)

Median OS: 61 months (planned) vs 51 months (unplanned)

No ASCT2 before relapse/TRM: HR, 1.00

0–6 months to ASCT2: HR, 3.69 (P<0.001)

6–12 months to ASCT2: HR, 2.97 (P<0.001)

>12 months to ASCT2: HR, 11.30 (P<0.001)

 Sellner L et al.66

200b,e

(ASCT2 after ASCT1 and HDT + melphalan reinduction therapy between 1995 and 2010)

ORR, day 100: 80%

Median PFS: 15.2 months

Median OS: 42.3 months

Within 100 days: 3%

Allo-SCT

 Bensinger W et al.75

80d

(allo-SCT after HDT±modified TBI)

ORR: 59%

4.5-year PFS probability: 20%

4.5-year OS probability: 24%

Within 100 days: 44%

 Bjorkstrand BB et al.76

189 case-matched pairs

(allo-SCT vs ASCT)

ORR: 86% vs 72%

(ASCT vs allo-SCT; P=0.001)

Median OS: 34 vs 18 months

(ASCT vs allo-SCT; P=0.001)

3 years: 41% vs 13%

(allo-SCT vs ASCT; P=0.0001)

 Qazilbash MH et al.79

40f

(Allo-SCT vs ASCT2 between 1992 and 2004)

n=14 allo-SCT

n=26 ASCT2

ORR: 69% vs 64%

Median PFS: 7.3 vs 6.8 months

Median OS: 13 vs 29.5 months

Within 100 days: 11% vs 7%

Overall: 27% vs 14%

 Mehta J et al.78

42 case-matched pairs

(allo-SCT between 1992 and 2006 vs ASCT2)

ORR: 62% vs 81% (P=0.05)

3-year PFS probability: 31±10% vs 72±9% (allo-SCT vs ASCT2; P=0.03)

3-year OS probability: 54±8% vs 29±9% (ASCT2 vs allo-SCT; P=0.01)

1-year probability: 43±8% vs 10±5%

(allo-SCT vs ASCT2; P=0.0001)

 Efebera Y et al.80

51f

(allo-SCT between 1996 and 2006)

2-year PFS rate: 19%

2-year OS rate: 32%

1 year: 25%

 Coman T et al.86

52b,d

(Len after allo-SCT between 2006 and 2009)

ORR: 83%

Median PFS: 18 months

Median OS: 30.5 months

4%

  1. Abbreviations: Allo-SCT=allogeneic stem cell transplant; ASCT1=initial autologous SCT; ASCT2=second autologous SCT; HDT=high-dose chemotherapy; HR=hazard ratio; Len=lenalidomide; ORR=overall response rate; OS=overall survival; PFS=progression-free survival; TBI=total body irradiation; TRM=transplant-related mortality.
  2. aExcluded patients participating in a tandem ASCT program.
  3. bRetrospective study.
  4. cRegistry-based study.
  5. dMulticenter study.
  6. eIncluded patients participating in a tandem ASCT program.
  7. fReduced-intensity myeloablative conditioning was performed prior to allo-SCT.