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    Imaging, QoL and Patient-Reported Outcome and Supportive Care

    Category: Imaging, QoL and Patient-Reported Outcome and Supportive Care

    Factors influencing the outcome of salvage second autologous stem cell transplant in relapsed multiple myeloma

    (PA-134) Factors Influencing the Outcome of Salvage Second Autologous Stem Cell Transplant in Relapsed Multiple Myeloma

    Friday, September 19, 2025

    • Yanjuan Li

      Postdoctor
      The First Affiliated Hospital, Sun Yat-sen University


    Introduction:      Salvage second autologous stem cell transplantation (ASCT2) is a therapeutic option for relapsed multiple myeloma (MM) following a prolonged response to initial autologous stem cell transplantation (ASCT1). However, its clinical relevance remains debated in the era of novel therapies, including anti-CD38 agents and immunotherapies.

    Methods:   This retrospective study analyzed MM patients who underwent ASCT2 after relapse post-ASCT1 at our center from January 2007 to March 2025. Median progression-free survival (PFS), overall survival (OS), and PFS2 (time from ASCT2 to progression) were estimated using the Kaplan-Meier method. Patients were stratified into two groups based on PFS2 (≥6 months vs. < 6 months) to compare clinical characteristics.

    Results:   Among 26 enrolled patients, the median follow-up was 78.5 months (IQR 64–115). The overall median PFS and OS were 30 (IQR 10–65) and 48 (IQR 27–67) months, respectively. Using a PFS2 cutoff of 6 months, 20 patients were classified into the PFS2≥6-month group and 6 patients into the PFS2< 6-month group. Compared to the PFS2≥6-month group, the PFS2< 6-month group exhibited younger median age at diagnosis and ASCT1, higher serum calcium at relapse, higher prevalence of extramedullary disease (EMD) at diagnosis and relapse, and increased incidence of infections within 100 days post-transplant (p< 0.05). No significant differences were observed in sex, M-protein type, hemoglobin levels, creatinine levels, albumin levels, β2-microglobulin levels, plasma cell percent of bone marrow, induction efficacy post-ASCT2, maintenance therapy, use of novel agents after first relapse, conditioning regimens, hematopoietic recovery time post-ASCT2, or intertransplant interval. Multivariate analysis confirmed younger age at diagnosis, elevated serum calcium at relapse, EMD at diagnosis and relapse, and post-transplant infections as independent risk factors for PFS2 (p< 0.05).

    Conclusions:   In MM patients undergoing ASCT2, younger age, hypercalcemia at relapse, and extramedullary infiltration correlate with inferior PFS2.