Risk factors of early disease progression and decreased survival for multiple myeloma patients after upfront autologous stem cell transplantation

Te-Lin Hsu; Chun-Kuang Tsai; Chun-Yu Liu; Chiu-Mei Yeh; Fen-Lan Lin; Liang-Tsai Hsiao; Yao-Chung Liu; Sheng-Hsuan Chien; Hao-Yuan Wang; Po-Shen Ko; Ting-An Lin; Wen-Chun Chen; Po-Min Chen; Jin-Hwang Liu; Jyh-Pyng Gau; Chia-Jen Liu

doi:10.1007/s00277-024-05641-y

Risk factors of early disease progression and decreased survival for multiple myeloma patients after upfront autologous stem cell transplantation

Ann Hematol. 2024 Mar 13. doi: 10.1007/s00277-024-05641-y. Online ahead of print.

Authors

Te-Lin Hsu^{1

2}, Chun-Kuang Tsai^{1

3}, Chun-Yu Liu^{3

4}, Chiu-Mei Yeh^{1

5}, Fen-Lan Lin⁴, Liang-Tsai Hsiao^{1

3}, Yao-Chung Liu^{1

3}, Sheng-Hsuan Chien^{3

4}, Hao-Yuan Wang^{1

3}, Po-Shen Ko^{1

3}, Ting-An Lin^{1

3}, Wen-Chun Chen^{1

3}, Po-Min Chen^{1

3}, Jin-Hwang Liu^{6

7

8}, Jyh-Pyng Gau^{1

3}, Chia-Jen Liu^{9

10

11

12}

Affiliations

¹ Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan.
² Division of Holistic and Multidisciplinary Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
³ School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁴ Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
⁵ Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁶ Section of Hematology and Oncology, Department of Internal Medicine, Cheng Hsin General Hospital, Taipei, Taiwan.
⁷ Institute of Biopharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁸ Chong Hin Loon Memorial Cancer and Biotherapy Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁹ Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan. chiajenliu@gmail.com.
¹⁰ School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. chiajenliu@gmail.com.
¹¹ Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. chiajenliu@gmail.com.
¹² Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. chiajenliu@gmail.com.

PMID: 38472362
DOI: 10.1007/s00277-024-05641-y

Abstract

Multiple myeloma (MM) stands as the second most prevalent hematological malignancy, constituting approximately 10% of all hematological malignancies. Current guidelines recommend upfront autologous stem cell transplantation (ASCT) for transplant-eligible MM patients. This study seeks to delineate factors influencing post-ASCT outcomes in MM patients. Our cohort comprised 150 MM patients from Taipei Veterans General Hospital, with progression-free survival (PFS) as the primary endpoint and overall survival (OS) as the secondary endpoint. A Cox proportional hazards model was employed to discern potential predictive factors for survival. ASCT age ≥ 65 (hazard ratio [HR] 1.94, 95% confidence interval [CI] 1.08-3.47) and the presence of extramedullary disease (HR 2.53, 95% CI 1.53-4.19) negatively impacted PFS. Conversely, treatment response ≥ VGPR before ASCT (HR 0.52, 95% CI 0.31-0.87) and total CD34⁺ cells collected ≥ 4 × 10⁶ cells/kg on the first stem cell harvesting (HR 0.52, 95% CI 0.32-0.87) were positively associated with PFS. For OS, patients with ISS stage III (HR 2.06, 95% CI 1.05-4.04), the presence of extramedullary disease (HR 3.92, 95% CI 2.03-7.58), light chain ratio ≥ 100 before ASCT (HR 7.08, 95% CI 1.45-34.59), post-ASCT cytomegalovirus infection (HR 9.43, 95% CI 3.09-28.84), and a lower conditioning melphalan dose (< 140 mg/m²; HR 2.75, 95% CI 1.23-6.17) experienced shorter OS. In contrast, post-ASCT day + 15 absolute monocyte counts (D15 AMC) > 500/µl (HR 0.36, 95% CI 0.17-0.79) and post-ASCT day + 15 platelet counts (D15 PLT) > 80,000/µl (HR 0.48, 95% CI 0.24-0.94) were correlated with improved OS. Significantly, early PLT and AMC recovery on day + 15 predicting longer OS represents a novel finding not previously reported. Other factors also align with previous studies. Our study provides real-world insights for post-ASCT outcome prediction beyond clinical trials.

Keywords: Autologous hematopoietic stem cell transplantation; Maintenance therapy; Monocyte count; Multiple myeloma; Platelet count.