Myeloma Patients Relapsing after First Line Treatment with Tandem Auto/Allo Transplant or Auto Transplant Only Have Similar Outcomes.
Bibliographic record
Abstract
Background A better survival in patients with multiple myeloma (MM) progressing after tandem autologous (auto)/allogeneic (allo) hematopoietic stem cell transplantation (HSCT) has been previously reported (Htut M. et al. BBMT 2018), suggesting a persistent graft-versus-multiple myeloma (GvMM) effect even after relapse. We sought to confirm this observation in a homogeneous cohort of MM patients who relapsed after upfront tandem auto/allo HSCT in our institution. Methods 92 consecutive, newly diagnosed MM patients who received tandem auto/allo HSCT were paired with 81 patients who received auto HSCT only between 2001 and 2010. Patients pairing criteria were age ≤ 65 years at diagnosis, Durie-Salmon 1B, 2 or 3, a glomerular filtration rate ≥ 60 mL/min, only one line of induction treatment, absence of progression within 4 months of auto HSCT and cytogenetics (if available). After their 1 st auto HSCT with high dose melphalan, all allo transplant recipients received an outpatient nonmyeloablative conditioning of fludarabine 30 mg/m 2 and cyclophosphamide 300 mg/m 2 × 5 days followed by G-CSF mobilized stem cells from a matched sibling donor. Results Median age in the auto/allo group was 53 years, compared to 57 years in the auto group (p<0.001). Both groups were similar for sex, immunoglobulin isotype, Durie-Salmon and ISS stages. With a median follow-up of 13.1 and 10.2 years (p<0.001), respectively, median overall survival (OS) in the tandem group has not been reached, compared to 6.1 years in the auto group only (p<0.001, Fig. 1). OS and PFS at 10 years in tandem and auto groups were 61% vs 37% (p<0.001) and 49% vs 22% (p<0.001), respectively. Disease progression occurred in 46 of 92 tandem recipients and 63 of 81 auto recipients, with an estimated 10-year cumulative incidence of progression (CIP) significantly lower in the tandem group (50% vs 77%; p<0.001, Fig. 2). Median OS at 10 years after 1 st progression was 39% in the tandem group and 22% in the auto group (p=0.062, Fig. 3). In multivariate analysis of factors associated with CIP, the only significant variable was tandem transplant (hazard ratio 0.44; 95% CI: 0.24-0.80, p=0.008), independently from age, ISS stage, type of induction and response before 1 st auto HSCT. Main cause of death was MM in both groups. Conclusion Tandem auto/allotransplant enables long-term survival and offers a potentially curative option in selected newly diagnosed MM patients. At time of 1 st relapse, tandem auto/allo transplant does not confer a significant outcome advantage compared to auto HSCT only.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".