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Changing practice patterns in autologous transplantation at EBMT centers

Sep 11, 2020

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 1and Figure 1.

Table 1. Study findings 1

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.

 

1993–1997

1998–2002

2003–2007

2008–2012

2013–2017

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, × 10 6CD34 +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

 

Figure 1. Progression-free survival and overall survival rates at 24 and 36 months 1


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.

  1. Hayden PJ, Eikema DJ, Koster L, et al. Trends in autologous transplantation for myeloma in EBMT centres between 1993 and 2017. Poster #O147. Virtual 46th Annual Meeting of the EBMT; Aug 29, 2020; Virtual.