Fiche publication
Date publication
juin 2022
Journal
Haematologica
Auteurs
Membres identifiés du Cancéropôle Est :
Dr LIOURE Bruno
Tous les auteurs :
Lawless S, Iacobelli S, Knelange NS, Chevallier P, Blaise D, Milpied N, Foà R, Cornelissen JJ, Lioure B, Benjamin R, Poiré X, Minnema MC, Collin M, Lenhoff S, Snowden JA, Santarone S, Wilson KMO, Trigo F, Dreger P, Böhmer LH, Putter H, Garderet L, Kröger N, Yaukoub-Agha I, Schönland S, Morris C
Lien Pubmed
Résumé
Primary Plasma Cell Leukaemia (pPCL) is a rare and challenging malignancy. There is limited data regarding optimum transplant approaches. Therefore we undertook a retrospective analysis from 1998-2014 of 751 patients with Primary Plasma Cell Leukaemia (pPCL) undergoing one of four transplant strategies; single autologous transplant (single-auto), single allogeneic transplant (allo-first) or a combined tandem transplant either auto-allo or 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 subsequent administration of second transplant. The allo-first group had lower relapse rate (45.9%, 95%CI 33.2-58.6 vs. 68.4%, 64.4-72.4) but higher NRM (27%, 95%CI 15.9-38.1 vs 7.3%, 5.2-9.4) at 36 months. Allo-first had remarkably higher risk in the first 100 days for both OS and PFS. Autoallo (n=122) had no increased risk in the short term and significant benefit in PFS post-100 days compared to single auto (HR 0.69, 95%CI: 0.52-0.92, p=0.012). Auto-auto (n=117) was an effective option for patients achieving CR prior to first transplant, whereas in patients without CR prior to transplant our modelling predicted that auto-allo was superior. This is the largest retrospective study reporting on transplant in pPCL to date. We confirm 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 guide clinical decisions on transplant strategy.
Référence
Haematologica. 2022 06 30;:
