Outcome of a Salvage Third Autologous Stem Cell Transplantation in Multiple Myeloma

  • Laurent Garderet
  • Simona Iacobelli
  • Linda Koster
  • Hartmut Goldschmidt
  • Jan-Erik Johansson
  • Jean Henri Bourhis
  • Marta Krejci
  • Xavier Leleu
  • Michael Potter
  • Didier Blaise
  • Christian Koenecke
  • Christian Peschel
  • Jakub Radocha
  • Bernd Metzner
  • Pascal Lenain
  • Kerstin Schäfer-Eckart
  • David Pohlreich
  • Mariella Grasso
  • Denis Caillot
  • Herman Einsele
  • Marco Ladetto
  • Stefan Schönland
  • Nicolaus Kröger


To evaluate the outcomes of salvage third autologous stem cell transplantation (ASCT) in patients with relapsed multiple myeloma. We analyzed 570 patients who had undergone a third ASCT between 1997 and 2010 (European Society for Blood and Marrow Transplantation data), of whom 482 patients underwent tandem ASCT and a third ASCT at first relapse (AARA group) and 88 patients underwent an upfront ASCT with second and third transplantations after subsequent relapses (ARARA group). With a median follow-up after salvage third ASCT of 61 months in the AARA group and 48 months in the ARARA group, the day +100 nonrelapse mortality in the 2 groups was 4% and 7%, the incidence of second primary malignancy was 6% and 7%, the median progression-free survival was 13 and 8 months, and median overall survival (OS) was 33 and 15 months. In the AARA group, according to the relapse-free interval (RFI) from the second ASCT, the median OS after the third ASCT was 17 months if the RFI was <18 months, 37 months if the RFI was between 18 and 36 months, and 64 months if the RFI was ≥36 months (P < .001). In the ARARA group, the median OS after the third ASCT was 7 months if the RFI was <6 months, 13 months if the RFI was between 6 and 18 months, and 27 months if the RFI was ≥18 months (P < .001). In a multivariate analysis of the AARA group, the favorable prognostic factor was an RFI after second ASCT of ≥18 months. Progressive disease and a Karnofsky Performance Status score of <70 at third ASCT were unfavorable factors. A salvage third ASCT is of value for patients with relapsed myeloma, particularly for those with a long duration of response and chemosensitive disease at the time of transplantation.

Bibliografische Daten

StatusVeröffentlicht - 07.2018
PubMed 29408334