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Comparison of autologous and allogeneic hematopoietic cell transplantation strategies in patients with primary plasma cell leukemia, with dynamic prediction modeling

Authors :
Sarah Lawless
Simona Iacobelli
Nina Simone Knelange
Patrice Chevallier
Didier Blaise
Noel Milpied
Roberto Foà
Jan J. Cornelissen
Bruno Lioure
Ruben Benjamin
Xavier Poiré
Monique C. Minnema
Matthew Collin
Stig Lenhoff
John A. Snowden
Stella Santarone
Keith M. O. Wilson
Fernanda Trigo
Peter Dreger
Lara H. Böhmer
Hein Putter
Laurent Garderet
Nicolaus Kröger
Ibrahim Yaukoub-Agha
Stefan Schönland
Curly Morris
Source :
Haematologica, Vol 108, Iss 4 (2022)
Publication Year :
2022
Publisher :
Ferrata Storti Foundation, 2022.

Abstract

Primary plasma cell leukemia (pPCL) is a rare and challenging malignancy. There are limited data regarding optimum transplant approaches. We therefore undertook a retrospective analysis from 1998-2014 of 751 patients with pPCL undergoing one of four transplant strategies; single autologous transplant (single auto), single allogeneic transplant (allo-first) or a combined tandem approach with an allogeneic transplant following an autologous transplant (auto-allo) or a tandem autologous transplant (auto-auto). To avoid time bias, multiple analytic approaches were employed including Cox models with time-dependent covariates and dynamic prediction by landmarking. Initial comparisons were made between patients undergoing allo-first (n=70) versus auto-first (n=681), regardless of a subsequent second transplant. The allo-first group had a lower relapse rate (45.9%, 95% confidence interval [95% CI]: 33.2-58.6 vs. 68.4%, 64.4-72.4) but higher non-relapse mortality (27%, 95% CI: 15.9-38.1 vs. 7.3%, 5.2-9.4) at 36 months. Patients who underwent allo-first had a remarkably higher risk in the first 100 days for both overall survival and progression-free survival. Patients undergoing auto-allo (n=122) had no increased risk in the short term and a significant benefit in progression-free survival after 100 days compared to those undergoing single auto (hazard ratio [HR]=0.69, 95% CI: 0.52- 0.92; P=0.012). Auto-auto (n=117) was an effective option for patients achieving complete remission prior to their first transplant, whereas in patients who did not achieve complete remission prior to transplantation our modeling predicted that auto-allo was superior. This is the largest retrospective study reporting on transplantation in pPCL to date. We confirm a significant mortality risk within the first 100 days for allo-first and suggest that tandem transplant strategies are superior. Disease status at time of transplant influences outcome. This knowledge may help to guide clinical decisions on transplant strategy.

Details

Language :
English
ISSN :
03906078 and 15928721
Volume :
108
Issue :
4
Database :
Directory of Open Access Journals
Journal :
Haematologica
Publication Type :
Academic Journal
Accession number :
edsdoj.3e9692070b124b73b7e2c431f2c27a7e
Document Type :
article
Full Text :
https://doi.org/10.3324/haematol.2021.280568