Hematopoietic cell transplantation utilization and outcomes for primary plasma cell leukemia in the current era.
Binod DhakalSagar S PatelSaulius GirniusLohith BachegowdaRaphael FraserOmar DavilaAbraham S KanateAmer AssalAmr HanbaliAsad BasheyAttaphol PawarodeCésar O FreytesCindy LeeDavid VesoleRobert Frank CornellGerhard C HildebrandtHemant S MurthyHillard M LazarusJan CernyJean A YaredJeffrey SchriberJesus BerdejaKeith Stockerl-GoldsteinKenneth MeehanLeona HolmbergMelhem SolhMiguel Angel DiazMohamed A Kharfan-DabajaNosha FarhadfarQaiser BashirReinhold MunkerRichard F OlssonRobert P GaleRuthlee-Lu BayerSachiko SeoSaurabh ChhabraShahrukh K. HashmiSherif M BadawyTaiga NishihoriWilson GonsalvesYago NietoYvonne A EfeberaShaji K KumarNina ShahMuzaffar H QazilbashParameswaran HariAnita D'SouzaPublished in: Leukemia (2020)
The outcomes of patients with primary plasma cell leukemia (pPCL) after undergoing hematopoietic cell transplantation (HCT) in the novel agent era are unknown. We report outcomes of 348 patients with pPCL receiving autologous (auto-) HCT (n = 277) and allogeneic (allo-) HCT (n = 71) between 2008 and 2015. Median age was 60 years and 56 years for auto- and allo-HCT respectively. For auto-HCT, the 4-year outcomes were: non-relapse mortality (NRM) 7% (4-11%), relapse (REL) 76% (69-82%), progression-free survival (PFS) 17% (13-23%), and overall survival (OS) 28% (22-35%). Karnofsky performance status (KPS) > 90 and ≥very good partial response (VGPR) predicted superior OS in multi-variate analysis for auto-HCT. For allo-HCT, the 4-year outcomes were: NRM 12% (5-21%), REL 69% (56-81%), PFS 19% (10-31%), and OS 31% (19-44%). Compared with prior CIBMTR pPCL patients (1995-2006), inferior survival was noted in the current cohort (3-year OS, 39% vs. 38% in allo-HCT, and 62% vs. 35% in auto-HCT) respectively. However, we noted an increased HCT utilization, from 12% (7-21%) in 1995 to 46% (34-64%) in 2009 using SEER data (available till 2009). Despite modern induction translating to higher proportion receiving HCT, the outcomes remain poor in pPCL patients, mainly derived by high relapse rates post-HCT.
Keyphrases
- cell cycle arrest
- free survival
- end stage renal disease
- cell death
- bone marrow
- newly diagnosed
- ejection fraction
- peritoneal dialysis
- prognostic factors
- chronic kidney disease
- pi k akt
- type diabetes
- single cell
- acute myeloid leukemia
- stem cells
- stem cell transplantation
- cardiovascular events
- mesenchymal stem cells
- cardiovascular disease
- risk factors
- deep learning
- high dose
- cell proliferation
- patient reported outcomes