Characteristics and outcomes of therapy-related myeloid neoplasms following autologous stem cell transplantation for multiple myeloma
Kalyan Nadiminti, M Hasib Sidiqi, Kapil Meleveedu, Hassan B. Alkhateeb, William J. Hogan, Mark R. Litzow, Mrinal M. Patnaik, Shaji Kumar, Morie A. Gertz, Dong Chen, Mithun Vinod Shah
Abstract
Advances over the last two decades have resulted in a significant improvement in survival of patients with multiple myeloma (MM)-primarily driven by the emergence of immunomodulators (IMiDs), proteasome inhibitors (PI) and monoclonal antibodies. Despite these improvements, high-dose melphalan (HDM)-based autologous stem cell transplantation (SCT) followed by lenalidomide maintenance remains part of standard initial therapy for transplant-eligible patients 1 . The development of therapyrelated myeloid neoplasms (t-MN) is an uncommon, but dreadful complication with considerable morbidity and poor survival. While the exposure to melphalan and autologous SCT are known risk factors 2,3 , the impact of lenalidomide, in the setting of HDM, is less clear 4-7 . Autologous SCT followed by lenalidomide maintenance leads to an improved progression-free-and overall survival, making it the de facto standard for eligible patients We studied the incidence of t-MN in post-SCT MM patients in the era of novel therapies and studied the impact of lenalidomide exposure on the risk of t-MN post-SCT. We also analyzed factors that may impact outcomes after t-MN diagnosis.