Patients with multiple myeloma (MM) undergoing autologous stem cell transplant (ASCT) have seen an increase in second primary malignancies (SPMs) since the introduction of novel agents, according to research published in Haematologica.

Researchers found that the risk of SPMs has increased since the introduction of proteasome inhibitors (PIs) and immunomodulatory drugs (IMiDs). However, only IMiDs and radiation (not PIs) were independent predictors of SPMs in this patient population.

In this retrospective study, researchers from Japan looked at risk factors for SPMs in MM patients who had undergone ASCT between 1995 and 2016. The study included 2340 patients, 43 of whom developed SPMs over a median follow-up of 24 months.

The cumulative incidence of SPMs was 0.8% at 24 months and 2.5% at 60 months. At 60 months, the cumulative incidence of hematologic SPMs was 0.8%, and the cumulative incidence of solid tumors was 1.8%.

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In a univariate analysis, the risk of SPMs increased from the pre-novel agent era (1995-2006) to the novel agent era (2007-2016). The rate of SPMs at 60 months was 1.9% in the pre-novel agent era and 4.3% in the novel agent era (P =.022).

The univariate analysis also revealed an increased risk of SPMs in patients who received IMiDs without PIs (P =.029) and those who received radiation (P =.003).

In a multivariate analysis, radiation was a significant predictor of SPMs (hazard ratio [HR], 4.151; 95% CI, 1.687-10.210; P =.002), as was IMiD treatment without PIs (HR, 2.738; 95% CI, 1.142-6.568; P =.024). PI treatment without IMiDs was not a risk factor for SPMs (HR, 1.183; 95% CI, 0.495-2.828; P =.710).

At 60 months after ASCT, the overall survival (OS) rate was 62.9%. At 24 months after SPM diagnosis, the OS rate was 72.2% for patients with hematologic SPMs and 70.9% for those with solid SPMs. The 60-month OS rate increased from 59.2% in the pre-novel agent era to 69.5% in the novel agent era (P <.0001).

“Considering the increase in the number of long-term survivors of MM, the occurrence of SPMs should be monitored cautiously,” the researchers wrote.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Takamatsu H, Matsuda T, Mizuno S, et al. Changing trends in the risk factors for second primary malignancies after autologous stem cell transplantation for multiple myeloma before and after the introduction of proteasome inhibitors and immunomodulatory drugs. Haematologica. Published online July 20, 2023. doi:10.3324/haematol.2023.283202

This article originally appeared on Cancer Therapy Advisor