Outcomes with Autologous or Allogeneic Stem Cell Transplantation in Patients with Plasma Cell Leukemia in the Era of Novel Agents
•Allogeneic stem cell transplantation (SCT) did not offer a significant survival advantage over autologous SCT.•Relapse with progressive disease was the main cause of death.•Patients with PCL should be included in clinical trials of novel immunotherapies. Plasma cell leukemia (PCL) is a rare and ver...
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Veröffentlicht in: | Biology of blood and marrow transplantation 2020-12, Vol.26 (12), p.e328-e332 |
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creator | Lemieux, Christopher Johnston, Laura J. Lowsky, Robert Muffly, Lori S. Craig, Juliana K. Shiraz, Parveen Rezvani, Andrew Frank, Matthew J. Weng, Wen-Kai Meyer, Everett Shizuru, Judith Arai, Sally Negrin, Robert Miklos, David B. Sidana, Surbhi |
description | •Allogeneic stem cell transplantation (SCT) did not offer a significant survival advantage over autologous SCT.•Relapse with progressive disease was the main cause of death.•Patients with PCL should be included in clinical trials of novel immunotherapies.
Plasma cell leukemia (PCL) is a rare and very aggressive plasma cell disorder. The optimal treatment approach, including whether to pursue an autologous (auto) or allogeneic (allo) stem cell transplantation (SCT) is not clear, given the lack of clinical trial-based evidence. This single-center retrospective study describes the outcomes of 16 patients with PCL (n = 14 with primary PCL) who underwent either autoSCT (n = 9) or alloSCT (n = 7) for PCL in the era of novel agents, between 2007 and 2019. The median age of the cohort was 58 years. High-risk cytogenetics were found in 50% of the patients. All patients received a proteasome inhibitor and/or immunomodulatory drug-based regimen before transplantation. At the time of transplantation, 10 patients (62%) obtained at least a very good partial response (VGPR). The response after autoSCT (3 months) was at least a VGPR in 6 patients (67%; complete response [CR] in 5). All patients undergoing alloSCT achieved a CR at 3 months. Maintenance therapy was provided to 5 patients (56%) after autoSCT. The median progression-free survival after transplantation was 6 months in the autoSCT group, compared with 18 months in the alloSCT group (P = .09), and median overall survival (OS) after transplantation in the 2 groups was 19 months and 40 months, respectively (P = .41). The median OS from diagnosis was 27 months and 49 months, respectively (P = .50). Of the 11 deaths, 10 patients (91%) died of relapsed disease. AlloSCT was not observed to offer any significant survival advantage over autoSCT in PCL, in agreement with recent reports, and relapse remains the primary cause of death in these patients. |
doi_str_mv | 10.1016/j.bbmt.2020.08.035 |
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Plasma cell leukemia (PCL) is a rare and very aggressive plasma cell disorder. The optimal treatment approach, including whether to pursue an autologous (auto) or allogeneic (allo) stem cell transplantation (SCT) is not clear, given the lack of clinical trial-based evidence. This single-center retrospective study describes the outcomes of 16 patients with PCL (n = 14 with primary PCL) who underwent either autoSCT (n = 9) or alloSCT (n = 7) for PCL in the era of novel agents, between 2007 and 2019. The median age of the cohort was 58 years. High-risk cytogenetics were found in 50% of the patients. All patients received a proteasome inhibitor and/or immunomodulatory drug-based regimen before transplantation. At the time of transplantation, 10 patients (62%) obtained at least a very good partial response (VGPR). The response after autoSCT (3 months) was at least a VGPR in 6 patients (67%; complete response [CR] in 5). All patients undergoing alloSCT achieved a CR at 3 months. Maintenance therapy was provided to 5 patients (56%) after autoSCT. The median progression-free survival after transplantation was 6 months in the autoSCT group, compared with 18 months in the alloSCT group (P = .09), and median overall survival (OS) after transplantation in the 2 groups was 19 months and 40 months, respectively (P = .41). The median OS from diagnosis was 27 months and 49 months, respectively (P = .50). Of the 11 deaths, 10 patients (91%) died of relapsed disease. AlloSCT was not observed to offer any significant survival advantage over autoSCT in PCL, in agreement with recent reports, and relapse remains the primary cause of death in these patients.</description><identifier>ISSN: 1083-8791</identifier><identifier>EISSN: 1523-6536</identifier><identifier>DOI: 10.1016/j.bbmt.2020.08.035</identifier><identifier>PMID: 32961371</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Allogeneic transplant ; Autologous transplant ; Plasma cell leukemia</subject><ispartof>Biology of blood and marrow transplantation, 2020-12, Vol.26 (12), p.e328-e332</ispartof><rights>2020 American Society for Transplantation and Cellular Therapy</rights><rights>Copyright © 2020 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c455t-5297407b85387ae68189353f75803a58d0c70e64b87e10adf3e817183d546a443</citedby><cites>FETCH-LOGICAL-c455t-5297407b85387ae68189353f75803a58d0c70e64b87e10adf3e817183d546a443</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.bbmt.2020.08.035$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32961371$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lemieux, Christopher</creatorcontrib><creatorcontrib>Johnston, Laura J.</creatorcontrib><creatorcontrib>Lowsky, Robert</creatorcontrib><creatorcontrib>Muffly, Lori S.</creatorcontrib><creatorcontrib>Craig, Juliana K.</creatorcontrib><creatorcontrib>Shiraz, Parveen</creatorcontrib><creatorcontrib>Rezvani, Andrew</creatorcontrib><creatorcontrib>Frank, Matthew J.</creatorcontrib><creatorcontrib>Weng, Wen-Kai</creatorcontrib><creatorcontrib>Meyer, Everett</creatorcontrib><creatorcontrib>Shizuru, Judith</creatorcontrib><creatorcontrib>Arai, Sally</creatorcontrib><creatorcontrib>Negrin, Robert</creatorcontrib><creatorcontrib>Miklos, David B.</creatorcontrib><creatorcontrib>Sidana, Surbhi</creatorcontrib><title>Outcomes with Autologous or Allogeneic Stem Cell Transplantation in Patients with Plasma Cell Leukemia in the Era of Novel Agents</title><title>Biology of blood and marrow transplantation</title><addtitle>Biol Blood Marrow Transplant</addtitle><description>•Allogeneic stem cell transplantation (SCT) did not offer a significant survival advantage over autologous SCT.•Relapse with progressive disease was the main cause of death.•Patients with PCL should be included in clinical trials of novel immunotherapies.
Plasma cell leukemia (PCL) is a rare and very aggressive plasma cell disorder. The optimal treatment approach, including whether to pursue an autologous (auto) or allogeneic (allo) stem cell transplantation (SCT) is not clear, given the lack of clinical trial-based evidence. This single-center retrospective study describes the outcomes of 16 patients with PCL (n = 14 with primary PCL) who underwent either autoSCT (n = 9) or alloSCT (n = 7) for PCL in the era of novel agents, between 2007 and 2019. The median age of the cohort was 58 years. High-risk cytogenetics were found in 50% of the patients. All patients received a proteasome inhibitor and/or immunomodulatory drug-based regimen before transplantation. At the time of transplantation, 10 patients (62%) obtained at least a very good partial response (VGPR). The response after autoSCT (3 months) was at least a VGPR in 6 patients (67%; complete response [CR] in 5). All patients undergoing alloSCT achieved a CR at 3 months. Maintenance therapy was provided to 5 patients (56%) after autoSCT. The median progression-free survival after transplantation was 6 months in the autoSCT group, compared with 18 months in the alloSCT group (P = .09), and median overall survival (OS) after transplantation in the 2 groups was 19 months and 40 months, respectively (P = .41). The median OS from diagnosis was 27 months and 49 months, respectively (P = .50). Of the 11 deaths, 10 patients (91%) died of relapsed disease. AlloSCT was not observed to offer any significant survival advantage over autoSCT in PCL, in agreement with recent reports, and relapse remains the primary cause of death in these patients.</description><subject>Allogeneic transplant</subject><subject>Autologous transplant</subject><subject>Plasma cell leukemia</subject><issn>1083-8791</issn><issn>1523-6536</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kcGP1CAYxRujcdfVf8CD4eilFQoUmhiTyWTVTSbuJq5nQunXGUZaRqBj9uh_Ls2MG7144iX8vvfBe0XxmuCKYNK821ddN6aqxjWusKww5U-KS8JrWjacNk-zxpKWUrTkongR4x5jLJhsnxcXtG4bQgW5LH7dzsn4ESL6adMOrebknd_6OSIf0MplDRNYg74mGNEanEP3QU_x4PSUdLJ-QnZCd1nBlM4ed07HUZ_gDczfYbR6odIO0HXQyA_oiz-CQ6vtMvSyeDZoF-HV-bwqvn28vl9_Lje3n27Wq01pGOep5HUrGBad5FQKDY0ksqWcDoJLTDWXPTYCQ8M6KYBg3Q8UJBFE0p6zRjNGr4oPJ9_D3I3Qm7w7aKcOwY46PCivrfr3ZrI7tfVHJXOKLauzwduzQfA_ZohJjTaa_Es9QQ5M1YxxRgnBIqP1CTXBxxhgeFxDsFq6U3u1dKeW7hSWKneXh978_cDHkT9lZeD9CYAc09FCUNHk3A30NoBJqvf2f_6_AZDHq-E</recordid><startdate>20201201</startdate><enddate>20201201</enddate><creator>Lemieux, Christopher</creator><creator>Johnston, Laura J.</creator><creator>Lowsky, Robert</creator><creator>Muffly, Lori S.</creator><creator>Craig, Juliana K.</creator><creator>Shiraz, Parveen</creator><creator>Rezvani, Andrew</creator><creator>Frank, Matthew J.</creator><creator>Weng, Wen-Kai</creator><creator>Meyer, Everett</creator><creator>Shizuru, Judith</creator><creator>Arai, Sally</creator><creator>Negrin, Robert</creator><creator>Miklos, David B.</creator><creator>Sidana, Surbhi</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20201201</creationdate><title>Outcomes with Autologous or Allogeneic Stem Cell Transplantation in Patients with Plasma Cell Leukemia in the Era of Novel Agents</title><author>Lemieux, Christopher ; Johnston, Laura J. ; Lowsky, Robert ; Muffly, Lori S. ; Craig, Juliana K. ; Shiraz, Parveen ; Rezvani, Andrew ; Frank, Matthew J. ; Weng, Wen-Kai ; Meyer, Everett ; Shizuru, Judith ; Arai, Sally ; Negrin, Robert ; Miklos, David B. ; Sidana, Surbhi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c455t-5297407b85387ae68189353f75803a58d0c70e64b87e10adf3e817183d546a443</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Allogeneic transplant</topic><topic>Autologous transplant</topic><topic>Plasma cell leukemia</topic><toplevel>online_resources</toplevel><creatorcontrib>Lemieux, Christopher</creatorcontrib><creatorcontrib>Johnston, Laura J.</creatorcontrib><creatorcontrib>Lowsky, Robert</creatorcontrib><creatorcontrib>Muffly, Lori S.</creatorcontrib><creatorcontrib>Craig, Juliana K.</creatorcontrib><creatorcontrib>Shiraz, Parveen</creatorcontrib><creatorcontrib>Rezvani, Andrew</creatorcontrib><creatorcontrib>Frank, Matthew J.</creatorcontrib><creatorcontrib>Weng, Wen-Kai</creatorcontrib><creatorcontrib>Meyer, Everett</creatorcontrib><creatorcontrib>Shizuru, Judith</creatorcontrib><creatorcontrib>Arai, Sally</creatorcontrib><creatorcontrib>Negrin, Robert</creatorcontrib><creatorcontrib>Miklos, David B.</creatorcontrib><creatorcontrib>Sidana, Surbhi</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Biology of blood and marrow transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lemieux, Christopher</au><au>Johnston, Laura J.</au><au>Lowsky, Robert</au><au>Muffly, Lori S.</au><au>Craig, Juliana K.</au><au>Shiraz, Parveen</au><au>Rezvani, Andrew</au><au>Frank, Matthew J.</au><au>Weng, Wen-Kai</au><au>Meyer, Everett</au><au>Shizuru, Judith</au><au>Arai, Sally</au><au>Negrin, Robert</au><au>Miklos, David B.</au><au>Sidana, Surbhi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes with Autologous or Allogeneic Stem Cell Transplantation in Patients with Plasma Cell Leukemia in the Era of Novel Agents</atitle><jtitle>Biology of blood and marrow transplantation</jtitle><addtitle>Biol Blood Marrow Transplant</addtitle><date>2020-12-01</date><risdate>2020</risdate><volume>26</volume><issue>12</issue><spage>e328</spage><epage>e332</epage><pages>e328-e332</pages><issn>1083-8791</issn><eissn>1523-6536</eissn><abstract>•Allogeneic stem cell transplantation (SCT) did not offer a significant survival advantage over autologous SCT.•Relapse with progressive disease was the main cause of death.•Patients with PCL should be included in clinical trials of novel immunotherapies.
Plasma cell leukemia (PCL) is a rare and very aggressive plasma cell disorder. The optimal treatment approach, including whether to pursue an autologous (auto) or allogeneic (allo) stem cell transplantation (SCT) is not clear, given the lack of clinical trial-based evidence. This single-center retrospective study describes the outcomes of 16 patients with PCL (n = 14 with primary PCL) who underwent either autoSCT (n = 9) or alloSCT (n = 7) for PCL in the era of novel agents, between 2007 and 2019. The median age of the cohort was 58 years. High-risk cytogenetics were found in 50% of the patients. All patients received a proteasome inhibitor and/or immunomodulatory drug-based regimen before transplantation. At the time of transplantation, 10 patients (62%) obtained at least a very good partial response (VGPR). The response after autoSCT (3 months) was at least a VGPR in 6 patients (67%; complete response [CR] in 5). All patients undergoing alloSCT achieved a CR at 3 months. Maintenance therapy was provided to 5 patients (56%) after autoSCT. The median progression-free survival after transplantation was 6 months in the autoSCT group, compared with 18 months in the alloSCT group (P = .09), and median overall survival (OS) after transplantation in the 2 groups was 19 months and 40 months, respectively (P = .41). The median OS from diagnosis was 27 months and 49 months, respectively (P = .50). Of the 11 deaths, 10 patients (91%) died of relapsed disease. AlloSCT was not observed to offer any significant survival advantage over autoSCT in PCL, in agreement with recent reports, and relapse remains the primary cause of death in these patients.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32961371</pmid><doi>10.1016/j.bbmt.2020.08.035</doi><oa>free_for_read</oa></addata></record> |
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subjects | Allogeneic transplant Autologous transplant Plasma cell leukemia |
title | Outcomes with Autologous or Allogeneic Stem Cell Transplantation in Patients with Plasma Cell Leukemia in the Era of Novel Agents |
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