Table 1.
Patient Baseline Characteristics and Outcomes
| Characteristic | R-MM (n=233) | NDR-MM (n=128) | DR-MM (n=105) | p-value* |
|---|---|---|---|---|
|
| ||||
| Median age, years (range) | 59 (23–79) | 56 (23–75) | 60 (35–79) | 0.005 |
|
| ||||
| Male sex | 138 (59%) | 73 (57%) | 65 (62%) | 0.50 |
|
| ||||
| Race | ||||
| White | 141 (61%) | 76 (59%) | 65 (62%) | 0.49 |
| Black | 57 (24%) | 36 (28%) | 21 (20%) | |
| Hispanic | 19 (8%) | 8 (6%) | 11 (10%) | |
| Other | 11 (5%) | 5 (4%) | 6 (6%) | |
| Unknown | 5 (2%) | 3 (2%) | 2 (2%) | |
|
| ||||
| Histologic Subtype | ||||
| IgA | 37 (16%) | 23 (18%) | 14 (13%) | 0.28 |
| IgG | 136 (58%) | 71 (55%) | 65 (62%) | |
| Light chain only | 37 (16%) | 24 (19%) | 13 (12%) | |
| Other | 23 (10%) | 10 (8%) | 13 (12%) | |
|
| ||||
| ISS Stage | ||||
| I | 54 (23%) | 29 (23%) | 25 (24%) | 0.58 |
| II | 40 (17%) | 26 (20%) | 14 (13%) | |
| III | 46 (20%) | 24 (19%) | 22 (21%) | |
| Unknown | 93 (40%) | 49 (38%) | 44 (42%) | |
|
| ||||
| Disease Status | ||||
| Primary Refractory | 153 (66%) | 95 (74%) | 58 (55%) | 0.003 |
| Relapsed Refractory | 80 (34%) | 33 (26%) | 47 (45%) | |
|
| ||||
| Response prior to transplant | ||||
| Stable Disease | 188 (81%) | 101 (79%) | 87 (83%) | 0.51 |
| Progressive Disease | 45 (19%) | 27 (21%) | 18 (17%) | |
| Partial response or better | 0 | 0 | 0 | |
|
| ||||
| KPS at auto-HCT, median (range) | 90 (40–100) | 90 (40–100) | 90 (60–100) | 0.28 |
|
| ||||
| High Risk Cytogenetics (high risk/patients tested) | 67/140 (48%) | 32/51 (63%) | 35/89 (39%) | 0.009 |
|
| ||||
| Bone marrow plasma cell (%), median (range) | 40 (0–100) | 40 (0–100) | 43 (0–95) | 0.20 |
|
| ||||
| Hemoglobin (g/dL), median (range) | 10.5 (4.2–17.0) | 10.6 (4.2–15.8) | 10.3(5.5–17.0) | 0.54 |
|
| ||||
| Lactate dehydrogenase (U/L), median (range) | 412 (68–1024) | 399 (83–1024) | 418 (68–962) | 0.78 |
|
| ||||
| Calcium (mg/dL), median (range) | 9.5 (6.8–16.9) | 9.6 (8.1–16.9) | 9.3 (6.8–16.1) | 0.021 |
|
| ||||
| Creatinine (mg/dL), median (range) | 1.1 (0.5–14.5) | 1.1 (0.5–14.5) | 1.1 (0.6–10) | 0.43 |
|
| ||||
| Beta-2-microglobulin (mg/L), median (range) | 3.4 (0.9–42.7) | 3.4 (0.9–33.7) | 3.6 (1.4–42.7) | 0.87 |
|
| ||||
| Induction Regimen | ||||
| Doublet | 117 (50%) | 75 (59%) | 42 (40%) | <0.001 |
| Triplet | 82 (35%) | 27 (21%) | 55 (52%) | |
| Other | 34 (15%) | 26 (20%) | 8 (8%) | |
|
| ||||
| Number of lines of prior therapy, median (range) | ||||
| Primary Refractory | 1 (1–5) | 1 (1–5) | 2 (1–5) | <0.001 |
| Relapsed/Refractory | 2 (1–7) | 2 (1–5) | 3 (1–7) | |
|
| ||||
| Time from diagnosis to auto-HCT (months), median (range) | 9.4 (2.2–309.6) | 8.1 (2.2–309.6) | 11.8 (3.2–220.8) | <0.001 |
|
| ||||
| Year of Transplantation | ||||
| 2000–2004 | 76 (32%) | 70 (55%) | 6 (6%) | NA |
| 2005–2009 | 55 (24%) | 24 (19%) | 31 (29%) | |
| 2010–2015 | 102 (44%) | 34 (26%) | 68 (65%) | |
|
| ||||
| Induction Regimen | ||||
| IMID+PI | NA | |||
| VRD | 38 (16 %) | 0 | 38 | |
| VTD | 11 (5%) | 0 | 11 | |
| VTD-PACE | 2 | 0 | 2 | |
| Other | 10 | 0 | 10 | |
| PI Based | ||||
| CyBorD | 20 | 13 | 7 | |
| VD | 14 | 9 | 5 | |
| mCBAD | 2 | 2 | 0 | |
| IMiD Based | ||||
| RD | 10 | 4 | 6 | |
| TD | 56 | 42 | 14 | |
| Other | ||||
| CVAD | 5 | 5 | 0 | |
| VAD | 16 | 14 | 2 | |
| Dexamethasone | 17 | 15 | 2 | |
| Melphalan/Prednisone | 11 | 9 | 2 | |
| Other | 21 | 13 | 8 | |
|
| ||||
| Chemomobilization | 94 (40%) | 40 (31%) | 54 (51%) | 0.002 |
|
| ||||
| Conditioning regimen | ||||
| Melphalan alone | 168 (72%) | 99 (77%) | 69 (66%) | 0.057 |
| Melphalan-based combination | 65 (28%) | 29 (23%) | 36 (34%) | |
|
| ||||
| Engraftment (days) | ||||
| Median neutrophil engraftment | 10 (0–19) | 10 (0–19) | 11 (9–13) | < 0.001 |
| Median platelet engraftment | 11 (0–34) | 10 (0–23) | 11 (0–34) | 0.016 |
|
| ||||
| Best Response to auto-HCT | ||||
| CR | 52 (22%) | 27 (21%) | 25 (24%) | 0.77 |
| VGPR | 43 (18%) | 27 (21%) | 16 (15%) | |
| PR | 93 (40%) | 51 (40%) | 42 (40%) | |
| SD | 31 (13%) | 15 (12%) | 16 (15%) | |
| PD | 13 (6%) | 7 (5%) | 6 (6%) | |
|
| ||||
| Day 100 response to auto-HCT | ||||
| CR | 28 (12%) | 17 (13%) | 11 (10%) | 0.45** |
| VGPR | 36 (15%) | 24 (19%) | 12 (11%) | |
| PR | 106 (45%) | 55 (43%) | 51 (49%) | |
| SD | 43 (18%) | 20 (16%) | 23 (22%) | |
| PD | 17 (7%) | 10 (8%) | 7 (7%) | |
| Unknown | 3 (1%) | 2 (2%) | 1 (1%) | |
|
| ||||
| Maintenance Therapy | ||||
| Lenalidomide | 55 | 26 | 29 | NA |
| Thalidomide/Dexamethasone | 15 | 13 | 2 | |
| Lenalidomide/Dexamethasone | 10 | 6 | 4 | |
| Bortezomib | 8 | 5 | 3 | |
| Lenalidomide/Ixazomib | 5 | 4 | 1 | |
| Thalidomide | 5 | 4 | 1 | |
| Dexamethasone | 3 | 2 | 1 | |
| Interferon | 5 | 4 | 1 | |
| Pomalidomide | 3 | 1 | 2 | |
| VRD | 2 | 1 | 1 | |
| Carfilzomib | 1 | 1 | 0 | |
| Other | 2 | 1 | 1 | |
R-MM: refractory multiple myeloma; NDR-MM: non-double refractory multiple myeloma; DR-MM: double refractory multiple myeloma; ISS: international staging system; KPS: karnofsky performance status; auto-HCT: autologous hematopoietic stem cell transplantation; VRD: bortezomib, lenalidomide, dexamethasone; VTD: bortezomib, thalidomide, dexamethasone; VTD-PACE: bortezomib, thalidomide, dexamethasone, cisplatin, doxorubicin, cyclophosphamide, etoposide; CyBorD: cyclophosphamide, bortezomib, dexamethasone; VD: bortezomib, dexamethasone; mCBAD: modified cyclophosphamide, bortezomib, doxorubicin, dexamethasone; RD: lenalidomide and dexamethasone; TD: thalidomide and dexamethasone; CVAD: cyclophosphamide, vincristine, doxorubicine and dexamethasone; VAD: vincristine, doxorubicin and dexamethasone; CR: complete response; VGPR: very good partial response; PR: partial response; SD: stable disease; PD: progressive disease
P-value represents comparative analysis of the DR-MM and NDR-MM groups.
Comparison was PR or better versus SD and PD.