American Society of Blood and Marrow Transplantation, European Society of Blood and Marrow Transplantation, Blood and Marrow Transplant Clinical Trials Network, and International Myeloma Working Group Consensus Conference on Salvage Hematopoietic Cell Transplantation in Patients with Relapsed Multiple Myeloma

Sergio Giralt, Laurent Garderet, Brian Durie, Gordon Cook, Gosta Gahrton, Benedetto Bruno, Paremesweran Hari, Henk Lokhorst, Phillip McCarthy, Amrita Krishnan, Pieter Sonneveld, Harmut Goldschmidt, Sundar Jagannath, Bart Barlogie, Maria Mateos, Peter Gimsing, Orhan Sezer, Joseph Mikhael, Jin Lu, Meletios Dimopoulos & 45 others Amitabha Mazumder, Antonio Palumbo, Rafat Abonour, Kenneth Anderson, Michel Attal, Joan Blade, Jenny Bird, Michele Cavo, Raymond Comenzo, Javier de la Rubia, Hermann Einsele, Ramon Garcia-Sanz, Jens Hillengass, Sarah Holstein, Hans Erik Johnsen, Douglas Joshua, Guenther Koehne, Shaji Kumar, Robert Kyle, Xavier Leleu, Sagar Lonial, Heinz Ludwig, Hareth Nahi, Anil Nooka, Robert Orlowski, Vincent Rajkumar, Anthony Reiman, Paul Richardson, Eloisa Riva, Jesus San Miguel, Ingemar Turreson, Saad Usmani, David Vesole, William Bensinger, Muzaffer Qazilbash, Yvonne Efebera, Mohamed Mohty, Christina Gasparreto, James Gajewski, Charles F. LeMaistre, Chris Bredeson, Phillipe Moreau, Marcelo Pasquini, Nicolaus Kroeger, Edward Stadtmauer

    Research output: Contribution to journalArticle

    76 Citations (Scopus)

    Abstract

    In contrast to the upfront setting in which the role of high-dose therapy with autologous hematopoietic cell transplantation (HCT) as consolidation of a first remission in patients with multiple myeloma (MM) is well established, the role of high-dose therapy with autologous or allogeneic HCT has not been extensively studied in MM patients relapsing after primary therapy. The International Myeloma Working Group together with the Blood and Marrow Transplant Clinical Trials Network, the American Society of Blood and Marrow Transplantation, and the European Society of Blood and Marrow Transplantation convened a meeting of MM experts to: (1) summarize current knowledge regarding the role of autologous or allogeneic HCT in MM patients progressing after primary therapy, (2) propose guidelines for the use of salvage HCT in MM, (3) identify knowledge gaps, (4) propose a research agenda, and (5) develop a collaborative initiative to move the research agenda forward. After reviewing the available data, the expert committee came to the following consensus statement for salvage autologous HCT: (1) In transplantation-eligible patients relapsing after primary therapy that did NOT include an autologous HCT, high-dose therapy with HCT as part of salvage therapy should be considered standard; (2) High-dose therapy and autologous HCT should be considered appropriate therapy for any patients relapsing after primary therapy that includes an autologous HCT with initial remission duration of more than 18 months; (3) High-dose therapy and autologous HCT can be used as a bridging strategy to allogeneic HCT; (4) The role of postsalvage HCT maintenance needs to be explored in the context of well-designed prospective trials that should include new agents, such as monoclonal antibodies, immune-modulating agents, and oral proteasome inhibitors; (5) Autologous HCT consolidation should be explored as a strategy to develop novel conditioning regimens or post-HCT strategies in patients with short (less than 18 months remissions) after primary therapy; and (6) Prospective randomized trials need to be performed to define the role of salvage autologous HCT in patients with MM relapsing after primary therapy comparing it to "best non-HCT" therapy. The expert committee also underscored the importance of collecting enough hematopoietic stem cells to perform 2 transplantations early in the course of the disease. Regarding allogeneic HCT, the expert committee agreed on the following consensus statements: (1) Allogeneic HCT should be considered appropriate therapy for any eligible patient with early relapse (less than 24 months) after primary therapy that included an autologous HCT and/or high-risk features (ie, cytogenetics, extramedullary disease, plasma cell leukemia, or high lactate dehydrogenase); (2) Allogeneic HCT should be performed in the context of a clinical trial if possible; (3) The role of postallogeneic HCT maintenance therapy needs to be explored in the context of well-designed prospective trials; and (4) Prospective randomized trials need to be performed to define the role salvage allogeneic HCT in patients with MM relapsing after primary therapy.

    Original languageEnglish (US)
    Pages (from-to)2039-2051
    Number of pages13
    JournalBiology of Blood and Marrow Transplantation
    Volume21
    Issue number12
    DOIs
    StatePublished - Dec 1 2015

    Fingerprint

    Cell Transplantation
    Multiple Myeloma
    Transplantation
    Bone Marrow
    Clinical Trials
    Transplants
    Therapeutics
    Plasma Cell Leukemia
    Salvage Therapy

    Keywords

    • Myeloma
    • Salvage therapy
    • Stem cell transplantation

    ASJC Scopus subject areas

    • Transplantation
    • Hematology

    Cite this

    American Society of Blood and Marrow Transplantation, European Society of Blood and Marrow Transplantation, Blood and Marrow Transplant Clinical Trials Network, and International Myeloma Working Group Consensus Conference on Salvage Hematopoietic Cell Transplantation in Patients with Relapsed Multiple Myeloma. / Giralt, Sergio; Garderet, Laurent; Durie, Brian; Cook, Gordon; Gahrton, Gosta; Bruno, Benedetto; Hari, Paremesweran; Lokhorst, Henk; McCarthy, Phillip; Krishnan, Amrita; Sonneveld, Pieter; Goldschmidt, Harmut; Jagannath, Sundar; Barlogie, Bart; Mateos, Maria; Gimsing, Peter; Sezer, Orhan; Mikhael, Joseph; Lu, Jin; Dimopoulos, Meletios; Mazumder, Amitabha; Palumbo, Antonio; Abonour, Rafat; Anderson, Kenneth; Attal, Michel; Blade, Joan; Bird, Jenny; Cavo, Michele; Comenzo, Raymond; de la Rubia, Javier; Einsele, Hermann; Garcia-Sanz, Ramon; Hillengass, Jens; Holstein, Sarah; Johnsen, Hans Erik; Joshua, Douglas; Koehne, Guenther; Kumar, Shaji; Kyle, Robert; Leleu, Xavier; Lonial, Sagar; Ludwig, Heinz; Nahi, Hareth; Nooka, Anil; Orlowski, Robert; Rajkumar, Vincent; Reiman, Anthony; Richardson, Paul; Riva, Eloisa; San Miguel, Jesus; Turreson, Ingemar; Usmani, Saad; Vesole, David; Bensinger, William; Qazilbash, Muzaffer; Efebera, Yvonne; Mohty, Mohamed; Gasparreto, Christina; Gajewski, James; LeMaistre, Charles F.; Bredeson, Chris; Moreau, Phillipe; Pasquini, Marcelo; Kroeger, Nicolaus; Stadtmauer, Edward.

    In: Biology of Blood and Marrow Transplantation, Vol. 21, No. 12, 01.12.2015, p. 2039-2051.

    Research output: Contribution to journalArticle

    Giralt, S, Garderet, L, Durie, B, Cook, G, Gahrton, G, Bruno, B, Hari, P, Lokhorst, H, McCarthy, P, Krishnan, A, Sonneveld, P, Goldschmidt, H, Jagannath, S, Barlogie, B, Mateos, M, Gimsing, P, Sezer, O, Mikhael, J, Lu, J, Dimopoulos, M, Mazumder, A, Palumbo, A, Abonour, R, Anderson, K, Attal, M, Blade, J, Bird, J, Cavo, M, Comenzo, R, de la Rubia, J, Einsele, H, Garcia-Sanz, R, Hillengass, J, Holstein, S, Johnsen, HE, Joshua, D, Koehne, G, Kumar, S, Kyle, R, Leleu, X, Lonial, S, Ludwig, H, Nahi, H, Nooka, A, Orlowski, R, Rajkumar, V, Reiman, A, Richardson, P, Riva, E, San Miguel, J, Turreson, I, Usmani, S, Vesole, D, Bensinger, W, Qazilbash, M, Efebera, Y, Mohty, M, Gasparreto, C, Gajewski, J, LeMaistre, CF, Bredeson, C, Moreau, P, Pasquini, M, Kroeger, N & Stadtmauer, E 2015, 'American Society of Blood and Marrow Transplantation, European Society of Blood and Marrow Transplantation, Blood and Marrow Transplant Clinical Trials Network, and International Myeloma Working Group Consensus Conference on Salvage Hematopoietic Cell Transplantation in Patients with Relapsed Multiple Myeloma', Biology of Blood and Marrow Transplantation, vol. 21, no. 12, pp. 2039-2051. https://doi.org/10.1016/j.bbmt.2015.09.016
    Giralt, Sergio ; Garderet, Laurent ; Durie, Brian ; Cook, Gordon ; Gahrton, Gosta ; Bruno, Benedetto ; Hari, Paremesweran ; Lokhorst, Henk ; McCarthy, Phillip ; Krishnan, Amrita ; Sonneveld, Pieter ; Goldschmidt, Harmut ; Jagannath, Sundar ; Barlogie, Bart ; Mateos, Maria ; Gimsing, Peter ; Sezer, Orhan ; Mikhael, Joseph ; Lu, Jin ; Dimopoulos, Meletios ; Mazumder, Amitabha ; Palumbo, Antonio ; Abonour, Rafat ; Anderson, Kenneth ; Attal, Michel ; Blade, Joan ; Bird, Jenny ; Cavo, Michele ; Comenzo, Raymond ; de la Rubia, Javier ; Einsele, Hermann ; Garcia-Sanz, Ramon ; Hillengass, Jens ; Holstein, Sarah ; Johnsen, Hans Erik ; Joshua, Douglas ; Koehne, Guenther ; Kumar, Shaji ; Kyle, Robert ; Leleu, Xavier ; Lonial, Sagar ; Ludwig, Heinz ; Nahi, Hareth ; Nooka, Anil ; Orlowski, Robert ; Rajkumar, Vincent ; Reiman, Anthony ; Richardson, Paul ; Riva, Eloisa ; San Miguel, Jesus ; Turreson, Ingemar ; Usmani, Saad ; Vesole, David ; Bensinger, William ; Qazilbash, Muzaffer ; Efebera, Yvonne ; Mohty, Mohamed ; Gasparreto, Christina ; Gajewski, James ; LeMaistre, Charles F. ; Bredeson, Chris ; Moreau, Phillipe ; Pasquini, Marcelo ; Kroeger, Nicolaus ; Stadtmauer, Edward. / American Society of Blood and Marrow Transplantation, European Society of Blood and Marrow Transplantation, Blood and Marrow Transplant Clinical Trials Network, and International Myeloma Working Group Consensus Conference on Salvage Hematopoietic Cell Transplantation in Patients with Relapsed Multiple Myeloma. In: Biology of Blood and Marrow Transplantation. 2015 ; Vol. 21, No. 12. pp. 2039-2051.
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    title = "American Society of Blood and Marrow Transplantation, European Society of Blood and Marrow Transplantation, Blood and Marrow Transplant Clinical Trials Network, and International Myeloma Working Group Consensus Conference on Salvage Hematopoietic Cell Transplantation in Patients with Relapsed Multiple Myeloma",
    abstract = "In contrast to the upfront setting in which the role of high-dose therapy with autologous hematopoietic cell transplantation (HCT) as consolidation of a first remission in patients with multiple myeloma (MM) is well established, the role of high-dose therapy with autologous or allogeneic HCT has not been extensively studied in MM patients relapsing after primary therapy. The International Myeloma Working Group together with the Blood and Marrow Transplant Clinical Trials Network, the American Society of Blood and Marrow Transplantation, and the European Society of Blood and Marrow Transplantation convened a meeting of MM experts to: (1) summarize current knowledge regarding the role of autologous or allogeneic HCT in MM patients progressing after primary therapy, (2) propose guidelines for the use of salvage HCT in MM, (3) identify knowledge gaps, (4) propose a research agenda, and (5) develop a collaborative initiative to move the research agenda forward. After reviewing the available data, the expert committee came to the following consensus statement for salvage autologous HCT: (1) In transplantation-eligible patients relapsing after primary therapy that did NOT include an autologous HCT, high-dose therapy with HCT as part of salvage therapy should be considered standard; (2) High-dose therapy and autologous HCT should be considered appropriate therapy for any patients relapsing after primary therapy that includes an autologous HCT with initial remission duration of more than 18 months; (3) High-dose therapy and autologous HCT can be used as a bridging strategy to allogeneic HCT; (4) The role of postsalvage HCT maintenance needs to be explored in the context of well-designed prospective trials that should include new agents, such as monoclonal antibodies, immune-modulating agents, and oral proteasome inhibitors; (5) Autologous HCT consolidation should be explored as a strategy to develop novel conditioning regimens or post-HCT strategies in patients with short (less than 18 months remissions) after primary therapy; and (6) Prospective randomized trials need to be performed to define the role of salvage autologous HCT in patients with MM relapsing after primary therapy comparing it to {"}best non-HCT{"} therapy. The expert committee also underscored the importance of collecting enough hematopoietic stem cells to perform 2 transplantations early in the course of the disease. Regarding allogeneic HCT, the expert committee agreed on the following consensus statements: (1) Allogeneic HCT should be considered appropriate therapy for any eligible patient with early relapse (less than 24 months) after primary therapy that included an autologous HCT and/or high-risk features (ie, cytogenetics, extramedullary disease, plasma cell leukemia, or high lactate dehydrogenase); (2) Allogeneic HCT should be performed in the context of a clinical trial if possible; (3) The role of postallogeneic HCT maintenance therapy needs to be explored in the context of well-designed prospective trials; and (4) Prospective randomized trials need to be performed to define the role salvage allogeneic HCT in patients with MM relapsing after primary therapy.",
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    author = "Sergio Giralt and Laurent Garderet and Brian Durie and Gordon Cook and Gosta Gahrton and Benedetto Bruno and Paremesweran Hari and Henk Lokhorst and Phillip McCarthy and Amrita Krishnan and Pieter Sonneveld and Harmut Goldschmidt and Sundar Jagannath and Bart Barlogie and Maria Mateos and Peter Gimsing and Orhan Sezer and Joseph Mikhael and Jin Lu and Meletios Dimopoulos and Amitabha Mazumder and Antonio Palumbo and Rafat Abonour and Kenneth Anderson and Michel Attal and Joan Blade and Jenny Bird and Michele Cavo and Raymond Comenzo and {de la Rubia}, Javier and Hermann Einsele and Ramon Garcia-Sanz and Jens Hillengass and Sarah Holstein and Johnsen, {Hans Erik} and Douglas Joshua and Guenther Koehne and Shaji Kumar and Robert Kyle and Xavier Leleu and Sagar Lonial and Heinz Ludwig and Hareth Nahi and Anil Nooka and Robert Orlowski and Vincent Rajkumar and Anthony Reiman and Paul Richardson and Eloisa Riva and {San Miguel}, Jesus and Ingemar Turreson and Saad Usmani and David Vesole and William Bensinger and Muzaffer Qazilbash and Yvonne Efebera and Mohamed Mohty and Christina Gasparreto and James Gajewski and LeMaistre, {Charles F.} and Chris Bredeson and Phillipe Moreau and Marcelo Pasquini and Nicolaus Kroeger and Edward Stadtmauer",
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    TY - JOUR

    T1 - American Society of Blood and Marrow Transplantation, European Society of Blood and Marrow Transplantation, Blood and Marrow Transplant Clinical Trials Network, and International Myeloma Working Group Consensus Conference on Salvage Hematopoietic Cell Transplantation in Patients with Relapsed Multiple Myeloma

    AU - Giralt, Sergio

    AU - Garderet, Laurent

    AU - Durie, Brian

    AU - Cook, Gordon

    AU - Gahrton, Gosta

    AU - Bruno, Benedetto

    AU - Hari, Paremesweran

    AU - Lokhorst, Henk

    AU - McCarthy, Phillip

    AU - Krishnan, Amrita

    AU - Sonneveld, Pieter

    AU - Goldschmidt, Harmut

    AU - Jagannath, Sundar

    AU - Barlogie, Bart

    AU - Mateos, Maria

    AU - Gimsing, Peter

    AU - Sezer, Orhan

    AU - Mikhael, Joseph

    AU - Lu, Jin

    AU - Dimopoulos, Meletios

    AU - Mazumder, Amitabha

    AU - Palumbo, Antonio

    AU - Abonour, Rafat

    AU - Anderson, Kenneth

    AU - Attal, Michel

    AU - Blade, Joan

    AU - Bird, Jenny

    AU - Cavo, Michele

    AU - Comenzo, Raymond

    AU - de la Rubia, Javier

    AU - Einsele, Hermann

    AU - Garcia-Sanz, Ramon

    AU - Hillengass, Jens

    AU - Holstein, Sarah

    AU - Johnsen, Hans Erik

    AU - Joshua, Douglas

    AU - Koehne, Guenther

    AU - Kumar, Shaji

    AU - Kyle, Robert

    AU - Leleu, Xavier

    AU - Lonial, Sagar

    AU - Ludwig, Heinz

    AU - Nahi, Hareth

    AU - Nooka, Anil

    AU - Orlowski, Robert

    AU - Rajkumar, Vincent

    AU - Reiman, Anthony

    AU - Richardson, Paul

    AU - Riva, Eloisa

    AU - San Miguel, Jesus

    AU - Turreson, Ingemar

    AU - Usmani, Saad

    AU - Vesole, David

    AU - Bensinger, William

    AU - Qazilbash, Muzaffer

    AU - Efebera, Yvonne

    AU - Mohty, Mohamed

    AU - Gasparreto, Christina

    AU - Gajewski, James

    AU - LeMaistre, Charles F.

    AU - Bredeson, Chris

    AU - Moreau, Phillipe

    AU - Pasquini, Marcelo

    AU - Kroeger, Nicolaus

    AU - Stadtmauer, Edward

    PY - 2015/12/1

    Y1 - 2015/12/1

    N2 - In contrast to the upfront setting in which the role of high-dose therapy with autologous hematopoietic cell transplantation (HCT) as consolidation of a first remission in patients with multiple myeloma (MM) is well established, the role of high-dose therapy with autologous or allogeneic HCT has not been extensively studied in MM patients relapsing after primary therapy. The International Myeloma Working Group together with the Blood and Marrow Transplant Clinical Trials Network, the American Society of Blood and Marrow Transplantation, and the European Society of Blood and Marrow Transplantation convened a meeting of MM experts to: (1) summarize current knowledge regarding the role of autologous or allogeneic HCT in MM patients progressing after primary therapy, (2) propose guidelines for the use of salvage HCT in MM, (3) identify knowledge gaps, (4) propose a research agenda, and (5) develop a collaborative initiative to move the research agenda forward. After reviewing the available data, the expert committee came to the following consensus statement for salvage autologous HCT: (1) In transplantation-eligible patients relapsing after primary therapy that did NOT include an autologous HCT, high-dose therapy with HCT as part of salvage therapy should be considered standard; (2) High-dose therapy and autologous HCT should be considered appropriate therapy for any patients relapsing after primary therapy that includes an autologous HCT with initial remission duration of more than 18 months; (3) High-dose therapy and autologous HCT can be used as a bridging strategy to allogeneic HCT; (4) The role of postsalvage HCT maintenance needs to be explored in the context of well-designed prospective trials that should include new agents, such as monoclonal antibodies, immune-modulating agents, and oral proteasome inhibitors; (5) Autologous HCT consolidation should be explored as a strategy to develop novel conditioning regimens or post-HCT strategies in patients with short (less than 18 months remissions) after primary therapy; and (6) Prospective randomized trials need to be performed to define the role of salvage autologous HCT in patients with MM relapsing after primary therapy comparing it to "best non-HCT" therapy. The expert committee also underscored the importance of collecting enough hematopoietic stem cells to perform 2 transplantations early in the course of the disease. Regarding allogeneic HCT, the expert committee agreed on the following consensus statements: (1) Allogeneic HCT should be considered appropriate therapy for any eligible patient with early relapse (less than 24 months) after primary therapy that included an autologous HCT and/or high-risk features (ie, cytogenetics, extramedullary disease, plasma cell leukemia, or high lactate dehydrogenase); (2) Allogeneic HCT should be performed in the context of a clinical trial if possible; (3) The role of postallogeneic HCT maintenance therapy needs to be explored in the context of well-designed prospective trials; and (4) Prospective randomized trials need to be performed to define the role salvage allogeneic HCT in patients with MM relapsing after primary therapy.

    AB - In contrast to the upfront setting in which the role of high-dose therapy with autologous hematopoietic cell transplantation (HCT) as consolidation of a first remission in patients with multiple myeloma (MM) is well established, the role of high-dose therapy with autologous or allogeneic HCT has not been extensively studied in MM patients relapsing after primary therapy. The International Myeloma Working Group together with the Blood and Marrow Transplant Clinical Trials Network, the American Society of Blood and Marrow Transplantation, and the European Society of Blood and Marrow Transplantation convened a meeting of MM experts to: (1) summarize current knowledge regarding the role of autologous or allogeneic HCT in MM patients progressing after primary therapy, (2) propose guidelines for the use of salvage HCT in MM, (3) identify knowledge gaps, (4) propose a research agenda, and (5) develop a collaborative initiative to move the research agenda forward. After reviewing the available data, the expert committee came to the following consensus statement for salvage autologous HCT: (1) In transplantation-eligible patients relapsing after primary therapy that did NOT include an autologous HCT, high-dose therapy with HCT as part of salvage therapy should be considered standard; (2) High-dose therapy and autologous HCT should be considered appropriate therapy for any patients relapsing after primary therapy that includes an autologous HCT with initial remission duration of more than 18 months; (3) High-dose therapy and autologous HCT can be used as a bridging strategy to allogeneic HCT; (4) The role of postsalvage HCT maintenance needs to be explored in the context of well-designed prospective trials that should include new agents, such as monoclonal antibodies, immune-modulating agents, and oral proteasome inhibitors; (5) Autologous HCT consolidation should be explored as a strategy to develop novel conditioning regimens or post-HCT strategies in patients with short (less than 18 months remissions) after primary therapy; and (6) Prospective randomized trials need to be performed to define the role of salvage autologous HCT in patients with MM relapsing after primary therapy comparing it to "best non-HCT" therapy. The expert committee also underscored the importance of collecting enough hematopoietic stem cells to perform 2 transplantations early in the course of the disease. Regarding allogeneic HCT, the expert committee agreed on the following consensus statements: (1) Allogeneic HCT should be considered appropriate therapy for any eligible patient with early relapse (less than 24 months) after primary therapy that included an autologous HCT and/or high-risk features (ie, cytogenetics, extramedullary disease, plasma cell leukemia, or high lactate dehydrogenase); (2) Allogeneic HCT should be performed in the context of a clinical trial if possible; (3) The role of postallogeneic HCT maintenance therapy needs to be explored in the context of well-designed prospective trials; and (4) Prospective randomized trials need to be performed to define the role salvage allogeneic HCT in patients with MM relapsing after primary therapy.

    KW - Myeloma

    KW - Salvage therapy

    KW - Stem cell transplantation

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    U2 - 10.1016/j.bbmt.2015.09.016

    DO - 10.1016/j.bbmt.2015.09.016

    M3 - Article

    VL - 21

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    JO - Biology of Blood and Marrow Transplantation

    JF - Biology of Blood and Marrow Transplantation

    SN - 1083-8791

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    ER -