Salvage therapy with high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) may lead to long-term improvements in survival for multiple myeloma (MM) in some patients, according to a study published in Cancers.
Survival rates have increased with daratumumab, a CD38-targeting monoclonal antibody, but some patients with MM become refractory. Patients who have disease progression after daratumumab treatment have poor outcomes.
The study retrospectively evaluated 69 heavily pretreated patients who underwent salvage ASCT after disease progression on daratumumab. All patients underwent melphalan-based stem cell transplantation upfront and had a median time from initial ASCT to salvage ASCT of 36.4 months.
Patients had undergone a median of 5 lines of therapy before salvage ASCT. At 100 days after salvage ASCT, 7 patients had died, 30 had a complete response (CR), 15 had a very good partial response (VGPR), and 10 had a partial response (PR).
The median progression free survival (PFS) was 7.3 months, and the median overall survival (OS) was 19.3 months. Patients with at least a VGPR had significantly better OS (34.4 months vs 10.6 months; P =.004).
The conditioning regimen did not have a significant effect on outcomes, indicating that salvage ASCT was the major contributor to improved outcomes. Older age, poor performance status, and high GEP70 risk score at diagnoses were associated with worse outcomes.
These results suggest that salvage ASCT may be an option in select heavily pretreated patients with daratumumab-refractory MM.
Disclosure: Some study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Yarlagadda L, Gundarlapalli S, Parikh R, et al. Salvage autologous stem cell transplantation in daratumumab-refractory multiple myeloma. Cancers (Basel). 2021;13(16):4019. doi:10.3390/cancers13164019