denotes an abstract that is clinically relevant.
denotes that this is a recommended PHD Trainee Session.
denotes that this is a ticketed session.Program: Oral and Poster Abstracts
Session: 731. Clinical Autologous Transplantation: Results: Poster I
Patients and Methods: We retrospectively analyzed outcomes of 237 consecutive MM patients (M132:F105) who underwent ASCT at Texas Transplant Institute, between December 2011 and June 2014. The study was approved by Institutional Review Board. The median length of follow-up was 44.8 months (10 – 86.8 months) in all patients. Censoring date was the last clinic visit prior to December 2014.
Results: A total of 237 MM patients were evaluated for presence of plasmacytomas. Patients presented either with multiple intraosseous lytic lesions (MM-IOL) without EMP (n=105; 44%); MM without lytic lesions or EMP in (n=80; 34%) and remaining MM-EMP (n=52; 22%) presented with EMP without multiple lytic lesions. Disease subtype was nonsecretory (5%; n=13), IGA (15%; n=35), IGG (56%; n=133), kappa light chain (16%; n=38) and lambda light chain (8%; n=18) for all 237 patients. (Table 1).Cytogenetics was available in 216 patients (91%) and statistically different among the 3 groups (p=0.05). The sites of EMP included the abdomen, pelvis, chest wall; liver, soft tissue, with sizes ranging from 1.8 cm 10 cm. EMP patients developed recurrent EMP after autologous transplant in 20% (10/52) cases. Fifty percent of patients with recurrent EMP (5/10) died of EMP progression.
A total of 140 (59%) patients received triple drug regimens either CyBorD (n=51; 22%) or VRD (n=89; 38%) prior to transplant. Radiation therapy was given to 42 % (n=22/52) patients with EMP and only 4% patients without EMP (n=8 /185). There was no difference in OS and PFS for patients treated with 2 drugs (VD/RD) compared to 3 drug regimens (CyBorD/VRD) for either OS or PFS. Prior solitary plasmacytoma were seen more frequently in 19% patients (n=10/52) who had EMP manifestations prior to transplant. Prior MGUS /smoldering myelomas were seen in 13 % MM-IOL patients. Disease characterisitics (p=0.0515), plasma cell percentage (p=0.0119) and disease recurrence (p=<0.0001) were statistically different for OS for all 237 patients. Disease characteristics (p=0.0751) and recurrence (p=<0.0001) were prognostic for PFS. 3 year probability of OS was 82% (95% CI, 64%- 92%), 84.7% (95% CI, 72%- 92%) and 71.6% (95% CI, 53%- 84%) for patients MM without EMP, MM-IOL and MM-EMP, respectively.
Conclusion: Novel therapeutic approaches including proteasome inhibitors and immunomodulatory agents followed by transplant can overcome poor prognosis of MM-EMP patients. Those that do relapse do extremely poorly suggesting need for alternative new therapies.
Table 1. Patient Characteristics
Variable |
All patients |
MM without IOL/EMP |
MM-IOL |
MM-EMP |
(M132:F105) |
(n=237)(100%) |
(n=80)(34%) |
(n=105)(44%) |
(n=52)(22%) |
Median age |
|
|
|
P=0.5038 |
|
63 (37-79) |
62 (40-76) |
63 (37-79) |
63 (39-77) |
MM subtype |
|
|
|
P=0.9589 |
IGG subtype |
133 (56%) |
45(56%) |
61(58%) |
28(23%) |
IGG kappa |
91 (38%) |
31(39%) |
42(40%) |
18(4%) |
IGG lambda |
42 (18%) |
14(18%) |
19(18%) |
9(17%) |
IGA Subtype |
35 (14.7%) |
13(16%) |
16(15.2%) |
6(12%) |
Kappa LCD |
38 (16%) |
14(18%) |
16(16%) |
8 (15%) |
Lambda LCD |
18 (8%) |
4(5%) |
8(8%) |
6(12%) |
Nonsecretory |
13 (6%) |
4(5%) |
4(4%) |
5(10%) |
Prior Plasma Cell Disorder* |
|
|
|
P=0.0001 |
Smoldering MM* |
7 (3%) |
3(4%) |
4(4%) |
0(0%) |
Plasmacytoma* |
13 (6%) |
1(1%) |
2(2%) |
10(19%) |
MGUS* |
26 (11%) |
13(16%) |
9(9%) |
4(8%) |
Cytogenetics |
|
|
|
P=0.0586 |
Normal Cytogenetics |
84(34%) |
41(51%) |
25(26%) |
27(54%) |
Mono 13/13 del |
22(13%) |
10(13%) |
20(19%) |
6(12%) |
17 del |
4(2%) |
1(1%) |
3(3%) |
1(2%) |
Trisomy 11/t(11:14) |
8(3%) |
6(8%) |
3(3%) |
6(12%) |
T(4:14) |
5(2%) |
2(2.5%) |
4(4%) |
2(4%) |
Hyperdiploidy |
22(9%) |
6(8%) |
11(10%) |
2(4%) |
Prior Treatments |
|
|
|
P=0.1122 |
CyBorD |
51(22%) |
19 (24%) |
26(25%) |
6(12%) |
VRD/VTD |
89(38%) |
27(34%) |
43(41%) |
18(34%) |
VD/RD/TD |
91(38%) |
30(38%) |
36(34%) |
24(46%) |
Other |
6(2.5%) |
3(4%) |
0(0%) |
3(6%) |
3 yr OS |
(p=0.462) |
86.1% (65%-95%) |
91.3% (81%-96%) |
83.4% (65%-93%) |
3 yr PFS |
(p=0.1302) |
82.8% (64%-92%) |
84.7% (72%-92%) |
71.6% (53%-84%) |
Disclosures: Shaughnessy: pharmacyclics: Honoraria , Membership on an entity’s Board of Directors or advisory committees ; millenium: Honoraria , Membership on an entity’s Board of Directors or advisory committees ; sonofi/genzyme: Honoraria , Membership on an entity’s Board of Directors or advisory committees , Speakers Bureau . Bachier: Regimmune: Research Funding .
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