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 DimopoulosAmitabha 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 journalReview article

    92 Scopus citations

    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 2015

    Keywords

    • Myeloma
    • Salvage therapy
    • Stem cell transplantation

    ASJC Scopus subject areas

    • Hematology
    • Transplantation

    Fingerprint Dive into the research topics of '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'. Together they form a unique fingerprint.

  • Cite this

    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., ... 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, 21(12), 2039-2051. https://doi.org/10.1016/j.bbmt.2015.09.016