Open AccessComparison of autologous and allogeneic hematopoietic cell transplantation strategies in patients with primary plasma cell leukemia, with dynamic prediction modeling
Author(s) -
Sarah Lawless,
Simona Iacobelli,
Nina Knelange,
Patrice Chevallier,
Didier Blaise,
Noël Milpied,
Roberto Foà,
Jan J. Cornelissen,
Bruno Lioure,
Ruben Benjamin,
Xavier Poiré,
Monique C. Minnema,
Matthew Collin,
Stig Lenhoff,
John A. Snowden,
Stella Santarone,
Keith Wilson,
Fernanda Trigo,
Peter Dreger,
Lara H. Böhmer,
Hein Putter,
Laurent Garderet,
Nicolaus Kröger,
Ibrahim Yaukoub-Agha,
Stefan Schönland,
Curly Morris
Publication year - 2022
Publication title -
haematologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.782
H-Index - 142
eISSN - 1592-8721
pISSN - 0390-6078
DOI - 10.3324/haematol.2021.280568
Subject(s) - medicine , hazard ratio , confidence interval , proportional hazards model , oncology , transplantation , malignancy , hematopoietic stem cell transplantation , hematopoietic cell , gastroenterology , surgery , haematopoiesis , stem cell , biology , genetics
Primary plasma cell leukemia (pPCL) is a rare and challenging malignancy. There are limited data regarding optimum transplant approaches. We therefore undertook a retrospective analysis from 1998-2014 of 751 patients with pPCL undergoing one of four transplant strategies; single autologous transplant (single auto), single allogeneic transplant (allo-first) or a combined tandem approach with an allogeneic transplant following an autologous transplant (auto-allo) or a tandem autologous transplant (auto-auto). To avoid time bias, multiple analytic approaches were employed including Cox models with time-dependent covariates and dynamic prediction by landmarking. Initial comparisons were made between patients undergoing allo-first (n=70) versus auto-first (n=681), regardless of a subsequent second transplant. The allo-first group had a lower relapse rate (45.9%, 95% confidence interval [95% CI]: 33.2-58.6 vs. 68.4%, 64.4-72.4) but higher non-relapse mortality (27%, 95% CI: 15.9-38.1 vs. 7.3%, 5.2-9.4) at 36 months. Patients who underwent allo-first had a remarkably higher risk in the first 100 days for both overall survival and progression-free survival. Patients undergoing auto-allo (n=122) had no increased risk in the short term and a significant benefit in progression-free survival after 100 days compared to those undergoing single auto (hazard ratio [HR]=0.69, 95% CI: 0.52- 0.92; P=0.012). Auto-auto (n=117) was an effective option for patients achieving complete remission prior to their first transplant, whereas in patients who did not achieve complete remission prior to transplantation our modeling predicted that auto-allo was superior. This is the largest retrospective study reporting on transplantation in pPCL to date. We confirm a significant mortality risk within the first 100 days for allo-first and suggest that tandem transplant strategies are superior. Disease status at time of transplant influences outcome. This knowledge may help to guide clinical decisions on transplant strategy.