Emma C. Scott, Oregon Health and Science University
Parameswaran Hari, Medical College of WisconsinFollow
Manish Sharma, Thomas Jefferson UniversityFollow
Jennifer Le-Rademacher, Medical College of Wisconsin
Jiaxing Huang, Medical College of Wisconsin
Dan Vogl, University of Pennsylvania
Muneer Abidi, Wayne State University
Amer Beitinjaneh, University of Miami
Henry Fung, Fox Chase Cancer Cente
Siddhartha Ganguly, University of Kansas Medical Center
Gerhard Hildebrandt, University of Kentucky Chandler Medical Center
Leona Holmberg, Fred Hutchinson Cancer Research Center
Matt Kalaycio, Cleveland Clinic Foundation
Shaji Kumar, Mayo Clinic Rochester
Robert Kyle, Mayo Clinic Rochester
Hillard Lazarus, University Hospitals Case Medical Center
Cindy Lee, Royal Adelaide Hospital
Richard T. Maziarz, Oregon Health and Science University
Kenneth Meehan, Dartmouth Hitchcock Medical Center
Joseph Mikhael, Mayo Clinic Arizona and Phoenix Children’s Hospital
Taiga Nishihori, H. Lee Moffitt Cancer Center and Research Institute
Muthalagu Ramanathan, UMass Memorial Medical Center
Saad Usmani, Levine Cancer Institute, Carolinas HealthCare System
Jason Tay, University of Ottawa
David Vesole, John Theurer Cancer Center at Hackensack UMC
Baldeep Wirk, Seattle Cancer Care Alliance
Jean Yared, University of Maryland
Bipin N. Savani, Vanderbilt University Medical Center
Cristina Gasparetto, Duke University Medical Center
Amrita Krishnan, City of Hope National medical Center
Tomer Mark, Weill Cornell Medical College
Yago Nieto, MD Anderson Cancer Center
Anita D'Souza, Medical College of Wisconsin

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This article has been peer reviewed. It is the authors' final version prior to publication in Biology of Blood and Marrow Transplantation, Volume 22, Issue 10, October 2016, Pages 1893-1899.

The published version is available at Copyright © Elsevier


Conventional cytogenetics and interphase fluorescence in situ hybridization (FISH) identify high-risk multiple myeloma (HRM) populations characterized by poor outcomes. We analyzed these differences among HRM versus non-HRM populations after upfront autologous hematopoietic cell transplantation (autoHCT). Between 2008 and 2012, 715 patients with multiple myeloma identified by FISH and/or cytogenetic data with upfront autoHCT were identified in the Center for International Blood and Marrow Transplant Research database. HRM was defined as del17p, t(4;14), t(14;16), hypodiploidy (-Y) or chromosome 1 p and 1q abnormalities; all others were non-HRM. Among 125 HRM patients (17.5%), induction with bortezomib and immunomodulatory agents (imids) was higher compared with non-HRM (56% versus 43%, P < .001) with similar pretransplant complete response (CR) rates (14% versus 16%, P .1). At day 100 post-transplant, at least a very good partial response was 59% in HRM and 61% in non-HRM (P = .6). More HRM patients received post-transplant therapy with bortezomib and imids (26% versus 12%, P = .004). Three-year post-transplant progression-free (PFS) and overall survival (OS) rates in HRM versus non-HRM were 37% versus 49% (P < .001) and 72% versus 85% (P < .001), respectively. At 3 years, PFS for HRM patients with and without post-transplant therapy was 46% (95% confidence interval [CI], 33 to 59) versus 14% (95% CI, 4 to 29) and in non-HRM patients with and without post-transplant therapy 55% (95% CI, 49 to 62) versus 39% (95% CI, 32 to 47); rates of OS for HRM patients with and without post-transplant therapy were 81% (95% CI, 70 to 90) versus 48% (95% CI, 30 to 65) compared with 88% (95% CI, 84 to 92) and 79% (95% CI, 73 to 85) in non-HRM patients with and without post-transplant therapy, respectively. Among patients receiving post-transplant therapy, there was no difference in OS between HRM and non-HRM (P = .08). In addition to HRM, higher stage, less than a CR pretransplant, lack of post-transplant therapy, and African American race were associated with worse OS. In conclusion, we show HRM patients achieve similar day 100 post-transplant responses compared with non-HRM patients, but these responses are not sustained. Post-transplant therapy appeared to improve the poor outcomes of HRM.

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This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

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