Changing practice patterns in autologous transplantation at EBMT centers

Over the last 25 years, the number of autologous hematopoietic cell transplantations (auto-HCT) for the treatment of transplant-eligible patients with multiple myeloma (MM) has increased.

During the Virtual 46th Annual Meeting of the European Society for Blood and Marrow Transplantation (EBMT), Patrick Hayden presented the results of a retrospective analysis of patients who underwent first auto-HCT for MM at EBMT centers between 1997 and 2018.¹

Methods

This retrospective analysis evaluated the trends in transplant use, patient selection, induction regimen, response to transplant, choice of mobilization regimen, stem cell doses, and survival over consecutive 5-year cohorts:

1. 1993–1997
2. 1998–2002
3. 2003–2007
4. 2008–2012
5. 2013–2017

All data were obtained from the EBMT registry.

Results

The study included 103,032 patients from 568 centers in 54 countries. Findings are reported in Table 1 and Figure 1.

Table 1. Study findings¹

	1993–1997	1998–2002	2003–2007	2008–2012	2013–2017
auto-HCT, autologous hematopoietic cell transplantation; CR, complete response; CTD, cyclophosphamide + thalidomide + dexamethasone; G-CSF, granulocyte colony-stimulating factor; PAD, bortezomib + doxorubicin + dexamethasone; PR, partial response; VCD, bortezomib + cyclophosphamide + dexamethasone; VD, bortezomib + dexamethasone; VRD, bortezomib + lenalidomide + dexamethasone; VTD, bortezomib + thalidomide + dexamethasone. *Data were available in 19,882 cases.
No. of auto-HCT	5,246	12,554	21,153	28,390	35,689
Median age at auto-HCT, years	54	57	58	59	61
Patients over 65 years at auto-HCT, %	3	9	14	14	22
Induction regimen, %*
VTD	—	—	—	11	32
VCD	—	—	—	5	20
CTD	—	—	—	15	10
VD	—	—	—	19	7
PAD	—	—	—	5	4
VRD	—	—	—	2	3
Response rates post induction, %
CR	16	14	13	20	21
PR	65	68	70	72	73
Stem cell mobilization regimens, %*
Cyclophosphamide + G-CSF	31	54	63	64	65
G-CSF only	69	45	36	31	28
G-CSF + plerixafor	—	—	—	3.5	5
Stem cell doses, × 106 CD34+ cells/kg
Total collection	5.1	5.2	6.3	6.6	6.5
Dose infused	3.6	4.1	4	3.8	3.8
Time from diagnosis to auto-HCT, months	8.9	7.7	7.4	7.4	7.3

OS, overall survival; PFS, progression-free survival. 

Conclusion

Over the last 25 years, the number of transplants has increased sevenfold, and the median age at transplant and the percentage of patients > 65 years at transplant has also increased. The choice of induction regimens has evolved, with a growing number of patients having received bortezomib-based triplet induction in the 2013─2017 cohort. A rise in the number and quality of responses and a significant improvement in progression-free survival and overall survival rates were observed, which supports the critical role of auto-HCT even in the novel agent era.