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  • Long-term survival of 1338 ...
    Costa, Luciano J; Iacobelli, Simona; Pasquini, Marcelo C; Modi, Riddhi; Giaccone, Luisa; Blade, Joan; Schonland, Stefan; Evangelista, Andrea; Perez-Simon, Jose A; Hari, Parameswaran; Brown, Elizabeth E; Giralt, Sergio A; Patriarca, Francesca; Stadtmauer, Edward A; Rosinol, Laura; Krishnan, Amrita Y; Gahrton, Gösta; Bruno, Benedetto

    Bone marrow transplantation, 09/2020, Letnik: 55, Številka: 9
    Journal Article

    Contrary to tandem autologous transplant (auto-auto), autologous followed by reduced intensity conditioning allogenic transplantation (auto-allo) offers graft-versus-myeloma (GVM) effect but with higher toxicity. Trials comparing these two strategies relied on availability of HLA-matched sibling donors for arm allocation (biological randomization) and yielded conflicting results. A pooled analysis of multiple trials with extended follow up provides an opportunity to compare these strategies. We obtained individual patient data from participants of four trials comparing auto-auto vs. auto-allo after induction therapy. There were 899 patients in auto-auto and 439 in auto-allo. Median follow up of survivors was 118.5 months. Median overall survival (OS) was 78.0 months in auto-auto and 98.3 months in auto-allo (HR = 0.84, P = 0.02). OS was 36.4% vs. 44.1% at 10 years (P = 0.01) for auto-auto and auto-allo, respectively. Progression-free survival was also improved in auto-allo (HR = 0.84, P = 0.004). Risk of non-relapse mortality was higher in auto-allo (10 year 8.3% vs. 19.7%, P < 0.001), while risk of disease progression was higher in auto-auto (10 year 77.2% vs. 61.6%, P < 0.001). Median post relapse survival was 41.5 months in auto-auto and 62.3 months in auto-allo (HR = 0.71, P < 0.001). This supports the existence of durable GVM effect enhancing myeloma control with subsequent therapies.