-Author name in bold denotes the presenting author
-Asterisk * with author name denotes a Non-ASH member
Clinically Relevant Abstract denotes an abstract that is clinically relevant.

PhD Trainee denotes that this is a recommended PHD Trainee Session.

Ticketed Session denotes that this is a ticketed session.

2289 International Differences in Baseline Characteristics and Practice Patterns in Patients with NEWLY Diagnosed Multiple Myeloma Undergoing Upfront Autologous STEM Cell Transplantation

Program: Oral and Poster Abstracts
Session: 905. Outcomes Research—Lymphoid Malignancies: Poster I
Hematology Disease Topics & Pathways:
adult, Plasma Cell Disorders, Diseases, Lymphoid Malignancies, Study Population, Human
Saturday, December 10, 2022, 5:30 PM-7:30 PM

Laurent Garderet, MD, PhD1, Luuk Gras2*, Linda Koster3*, Anita D'Souza, MD, MS4, Noel Estrada-Merly5*, Parameswaran Hari, MD, MRCP6, Wael Saber, MD, MS5, Andrew J Cowan, MD7, Minako Iida, MD, PhD8*, Shinichiro Okamoto, MD, PhD9, Hiroyuki Takamatsu, MD, PhD10, Shohei Mizuno, MD, PhD11*, Koji Kawamura12*, Yoshihisa Kodera, MD13*, Nada Hamad, MBBS, BSc, MSc14, Bor-Sheng Ko, MD, PhD15*, Christopher Liam16, Kim Wah Ho, MBBS, MRCP17*, A Sim Goh18*, S Keat Tan18*, Alaa M. Elhaddad, MD19, Ali Bazarbachi, MD, PhD20, Qamar un Nisa Chaudhry21*, Rozan Alfar, MBBS22*, Mohamed-Amine Bekadja23*, Malek Benakli, MD, PhD24, Cristobal Augusto Frutos Ortiz, MD25*, Eloisa Riva, MD, MEd26, Sebastian Galeano, MD27, Francisca Bass, MD28*, Hira S Mian, MD29, Arleigh McCurdy, MD, BSc30, Feng Rong Wang31*, Daniel Neumann32*, Mickey Koh, MD, PhD33*, John A Snowden34, Stefan Schönland35*, Donal P. McLornan, MD, PhD36*, Patrick John Hayden, MD37, Anna Sureda38, Hildegard T. Greinix, MD39, Mahmoud Aljurf, MD40, Yoshiko Atsuta41* and Dietger Niederwieser, MD42

1Service Hematologie, Sorbonne Université, Hopital Pitié Salpêtière APHP, Paris, France
2EBMT Statistical Unit, Leiden, The Netherlands, Leiden, Netherlands
3EBMT Data Office, Leiden, Netherlands
4Department of medicine, medical college of Wisconsin, Milwaukee
5CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
6Medical College of Wisconsin, Milwaukee, WI
7Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
8Aichi Medical University School of Medicine, Nagakute-cho, Aichi, JPN
9Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
10​School of Entrepreneurial and Innovation Studies, Kanazawa University, Kanazawa, Japan
11Department of Hematology, Aichi Medical University School of Medicine, Nagakute, AIC, Japan
12Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, SAI, Japan
13Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine, Nagoya, Japan
14Department of Haematology, St Vincent's Hospital Sydney, Australia and St Vincent's Clinical School, Sydney, University of New South Wales, Sydney, NSW, Australia
15National Taiwan University Hospital, Taipei, Taiwan
16Hospital Ampang, Ampang, Selangor, Malaysia
17Department of Hematology, Ampang Hospital, Ampang, Malaysia
18Penang general hospital, Penang, Malaysia
19Department of Pediatric Oncology and Stem Cell Transplantation Unit, National Cancer Institute, Cairo University, Cairo, Egypt
20American University of Beirut Dept. of Medicine, Beirut, Lebanon
21AFBMTC/NIBMT, Rawalpindi, Pakistan
22King Hussein cancer center, Amman, ON, Jordan
23Department of Hematology and Cell Therapy, EHU 1st Novembre 1954 Bir el Djir Usto, University Ahmed Benbella 1, Oran, Algeria
24Centre Pierre et Marie Curie (CPMC), Algiers, Algeria
25Hospital Central Del Instituto De Prevision Social, Asuncion, Paraguay
26Cátedra de Hematología, Hospital de Clínicas, Facultad de Medicina, Montevideo, Montevideo, Uruguay
27Hematology Department, British Hospital, Montevideo, Montevideo, Uruguay
28Hospital del Salvador, Santiago, Chile
29Department of Oncology, McMaster University, Hamilton, ON, Canada
30Department of Medicine, Division of Hematology, The Ottawa Hospital, Ottawa, ON, Canada
31Peking University, Beijing, China
32IMISE, university of Leipzig, Leipzig, Germany
33Department of Haematology, St George's Hospital NHS Foundation Trust, London, United Kingdom
34BSBMTCT, Department of Haematology, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
35Department of Internal Medicine V, Amyloidosis Center, Heidelberg University Hospital, Heidelberg, Germany
36Department of Haematology, Kings's College Hospital, London, ENG, United Kingdom
37Department of Haematology, Trinity College Dublin, St. James's Hospital, Dublin 8, Leinster, Ireland
38Institut Català d'Oncologia, Hospital Duran i Reynals. Institut d’Investigació Biomèdica de Bellvitge (IDIBELL). Universitat de Barcelona, Barcelona, Spain
39Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
40Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
41Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan
42University of Leipzig, Leipzig, Germany


Worldwide, patients with newly diagnosed multiple myeloma (NDMM) undergoing upfront autologous stem cell transplantation (ASCT) have different characteristics and survival outcomes, likely due to variances in transplant activity, patient and health economic factors including access to new myeloma therapies. The goal of this retrospective study was to analyze differences in regional outcomes.


Data on patient characteristics and transplant outcomes for patients with NDMM who received an upfront ASCT between 2013 and 2017 were provided to the Worldwide Network for Blood and Marrow Transplantation (WBMT) by the European Society for Blood and Marrow Transplantation (EBMT), the Center for International Blood and Marrow Transplantation (CIBMTR), the Asian Pacific Blood and Marrow Transplant Group (APBMT), the Australia and New Zealand Transplant and Cellular Therapies Registry (ANZTCT), the Eastern Mediterranean Blood and Marrow Transplant Group (EMBMT), the Latin American Bone Marrow Transplant Group (LABMT), and the Ottawa Canadian Registry. There primary endpoints were overall (OS) and non-relapse mortality (NRM) and the secondary were progression free survival (PFS) and relapse incidence (RI). The Kaplan-Meier estimator and log-rank test were used for OS and PFS, and the crude cumulative incidence estimator and Gray’s test were used for competing events (RI and NRM).


61725 patients from 629 were included: 37549 (61%) from EBMT, 16217 (26%) CIBMTR), 3815 (6%) APBMT (3122 Japan, 524 Taiwan and 169 Malaysia), 3,164 (5%) ANZTCT, 543 (0.9%) EMBMT, 339 (0.5%) LABMT and 188 (0.3%) Ottawa). The annual number of ASCTs steadily increased between 2013 (n=11317) and 2017 (n=13498) with the biggest relative increase seen in LABMT (from 36 to 109). Males comprised 58% and the median age at diagnosis was 59.9 years (IQR: 53.6-64.9). Race data was available in 45%: 73% White, 16% Asian and 11% African American. The predominant phenotypes were IgG (54%), light chain (24%) (lowest (4%) in Malaysia and highest (38%) in EMBMT), and IgA (19%) (lowest (13%) in EMBMT and highest (24%) in Ottawa). The ISS stage at diagnosis (54% available) was I in 38%, II 35% and III 27% (III lowest (24%) in ANZTCT and highest (45%) in LABMT). Cytogenetic risk (44% available) was standard in 70% and high in 30% (high risk was lowest (5%) in EMBMT, and highest (62%) in Ottawa). The median time from diagnosis to ASCT was 7 months (IQR:5.5-9.9) (shortest (6.4) in CIBMTR and Ottawa, and longest (13) in LABMT). The median age at ASCT was 60.8 years (IQR: 54.6-65.8) (lowest (53.6) in EMBMT, and highest (62) in Ottawa). Only 5% of patients were older than 70 years (lowest (3.5%) in EBMT, and highest (9.8%) in CIBMTR). HCT-CI at ASCT (28% missing) was reported as low risk (0) in 52%, intermediate (1-2) 25% and high risk (≥3) 23% (high risk was lowest (5.5%) in LABMT and highest (42%) in CIBMTR). The Karnofsky score at ASCT (2.2 % missing) was 100 in 40% and ≤90 in 60% (≤90 was lowest (44%) in LABMT and highest (92%) in Ottawa). Disease status (9.7% missing) was CR in 19%, VGPR 38%, PR 36%, MR/SD 5% and refractory 2%. A ≥VGPR status at ASCT was 60% in EBMT, 55% CIBMTR, 39% ANZTCT, 51% Japan, 64% EMBMT, 71% Taiwan, 76% LABMT, 51% Ottawa and 54% Malaysia. The most frequent preparative regimen was melphalan 200 mg/m2 (82 %) (lowest (60%) in Malaysia and highest (90%) in Ottawa), 140 mg/m2 accounted for 14% and others for 4%. Tandem ASCT was reported in 6.7% (10% in EBMT, 1.3% in CIBMTR and 0.6% LABMT and Taiwan). The source of stem cells was peripheral blood in 99.8%. Of the 11% reported with post-ASCT maintenance treatment, 51% received lenalidomide. The median follow-up was 41.1 months (95% CI: 40.5-41.6, IQR:19.2-60.4). Regionally, at 3 years, the OS was : 81%, 84%, 82%, 83%, 77%, 75%, 84%, 82%, 69% (p<0.001), the PFS was 46%, 55%, 48%, 63%, 44%, 53%, 56%, 53%, 43% (p<0.001) (Figure) and the RI was:16%, 15%, 16%, 17%, 24%, 16%, 16%, 13%, 24% (p<0.001) for EBMT, CIBMTR, ANZTCT, Japan, EMBMT, Taiwan, LABMT, Ottawa and Malaysia, respectively. NRM at 1 year was between 1-2% in each registry (Figure).


This large worldwide study of patients with NDMM treated with upfront ASCT revealed marked regional differences in transplant activity and patient characteristics. NRM was low worldwide but with differences in relapse incidence and survival potentially reflect variable health economic factors, including different access to new myeloma drugs.

Disclosures: Garderet: BMS: Honoraria; Sanofi: Honoraria; Janssen: Honoraria. D'Souza: Takeda, Sanofi, TeneoBio, Prothena, Caelum Biosciences, Janssen Oncology, Regeneron, AbbVie: Research Funding; Pfizer, Janssen Oncology, Bristol Myers Squibb/Celgene, Prothena: Consultancy, Membership on an entity's Board of Directors or advisory committees. Hari: GlaxoSmithKline: Honoraria; Kite: Consultancy, Honoraria; Incyte: Honoraria; Takeda: Consultancy, Honoraria; BMS: Consultancy, Honoraria, Research Funding; Novartis: Honoraria; Sanofi: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; AbbVie: Honoraria; Pharmacyclics: Consultancy; Karyopharm: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Millennium: Research Funding; Spectrum Pharmaceuticals: Research Funding; Iovance: Current Employment. Cowan: Abbvie: Consultancy, Research Funding; Adaptive: Membership on an entity's Board of Directors or advisory committees; Allogene: Consultancy; BMS: Consultancy, Research Funding; EUSA: Consultancy; GSK: Consultancy; Harpoon: Research Funding; Janssen: Consultancy, Research Funding; Nektar: Research Funding; Sanofi: Research Funding; Secura Bio: Consultancy. Takamatsu: SRL: Consultancy; Janssen: Honoraria; Ono: Honoraria; Sanofi: Honoraria; Bristol-Myers Squibb: Honoraria. Hamad: Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Mian: Sanofi: Consultancy, Honoraria; BMS: Consultancy, Honoraria; Janssen: Consultancy, Honoraria, Research Funding; Amgen: Consultancy, Honoraria; Takeda: Consultancy, Honoraria. McCurdy: Sanofi: Honoraria; GSK: Honoraria; Amgen: Honoraria; Forus: Honoraria; BMS: Honoraria, Research Funding; Janssen: Honoraria; Takeda: Honoraria. Snowden: Novartis: Speakers Bureau; Mallinckrodt: Speakers Bureau; Gilead: Speakers Bureau; Janssen and Jazz: Speakers Bureau; Medac: Membership on an entity's Board of Directors or advisory committees; Kiadis: Other: clinical trial IDMC membership . Schönland: Pfizer: Honoraria; Takeda: Honoraria, Other: Travel Support; Janssen: Honoraria, Other: travel support, Research Funding; Prothena: Honoraria, Other: Travel Support, Research Funding. McLornan: ABBVIE: Speakers Bureau; CELGENE BMS: Research Funding, Speakers Bureau; JAZZ: Honoraria, Speakers Bureau; NOVARTIS: Honoraria, Research Funding, Speakers Bureau. Hayden: Amgen: Other: Participation in Advisory Board. Sureda: TAKEDA: Consultancy, Honoraria, Speakers Bureau; MSD: Honoraria; SANOFI: Consultancy, Honoraria; NOVARTIS: Consultancy, Honoraria; ROCHE: Consultancy, Honoraria; BMS: Consultancy, Honoraria; JANSSEN: Consultancy, Honoraria; GILEAD: Consultancy. Greinix: Gilead, Novartis, Sanofi, Cellgene: Consultancy; Amgen, Gilead, Novartis, Sanofi, Takeda, Therakos: Speakers Bureau. Atsuta: Novartis Pharma KK: Honoraria; Meiji Seika Pharma Co, Ltd.: Honoraria; Mochida Pharmaceutical Co., Ltd.: Honoraria; Kyowa Kirin Co., Ltd: Honoraria; Astellas Pharma Inc.: Honoraria; AbbVie GK: Honoraria.

*signifies non-member of ASH