Nicolaus Kröger, MD, a professor and medical director of the Department of Stem Cell Transplantation at the University Hospital Hamburg-Eppendorf, in Hamburg, Germany, discusses toxicities associated with allogeneic stem cell transplant in patients with multiple myeloma.

Allogeneic stem cell transplantation is an immunotherapy that has been working efficiently in patients with multiple myeloma, according to Kröger. The efficacy of immunotherapy has been observed with novel therapies, such as new antibody treatments, CAR T-cell therapies, and stem cell transplantation wherein donor T cells are the major effector that can elicit a graft-versus-myeloma effect. This effect can help to deepen remission and induce a higher rate of complete remission, regardless of whether a risk of relapse still exists, Kröger says.

However, the T cells do not specifically target myeloma cells, and will also target other cells in the patient and induce graft-versus host disease (GVHD). New options have emerged to help treat or prevent GVHD; however, it is important to be careful, as GVHD prevention can result in a lower graft-versus-myeloma effect. This translates to a higher risk of relapse, Kröger concludes.

Videos

Nicolaus Kröger, MD, discusses toxicities associated with allogeneic stem cell transplant in patients with multiple myeloma.

Dr. Kröger on Toxicities Associated With Allogeneic Stem Cell Transplant in Myeloma

Nicolaus Kröger, MD, a professor and medical director of the Department of Stem Cell Transplantation at the University Hospital Hamburg-Eppendorf, Hamburg, Germany, discusses the role of allogenic stem cell transplant in patients with multiple myeloma.

Curing multiple myeloma is a challenge, even with the advent of novel agents and CAR T-cell therapy, Kröger says. Only a small portion of patients can be cured; nearly all patients relapse at some point, Kröger says. However, data from large registry studies on the long-term use of allogenic stem cell transplantation indicate that a number of patients can be cured through transplant, Kröger explains.

Therefore, for a young patient who has relapsed following autograft, allogenic stem cell transplantation should be considered as a potentially curative treatment approach, even if novel agents are available, Kröger adds. There has only been a lack of long-term follow up for the majority of novel agents in this disease, Kröger says. Although CAR T-cell therapies are known to be effective, they are often used in a later-stage setting, with most patients relapsing after a relatively progression-free time period, Kröger concludes.

Nicolaus Kröger, MD, discusses the role of allogenic stem cell transplant in patients with multiple myeloma.


Dr. Kröger on the Role of Allogenic Stem Cell Transplant in Multiple Myeloma

Nicolaus Kröger, MD, professor, medical director, Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany, discusses the long-term results of a phase 2 study in multiple myeloma. 

During the 47th Annual Meeting of the EBMT, updated results of a prospective, phase 2 study (NCT00777998) comparing tandem stem cell transplantation approaches plus maintenance thalidomide (Thalomid) in patients with multiple myeloma were presented virtually. The study evaluated 210 patients up to the age of 60 with multiple myeloma who underwent autologous stem cell transplant and allogeneic stem cell transplant (auto-allo) or autologous tandem transplant (auto-auto). Both regimens were followed by maintenance thalidomide. 

The 8-year progression-free survival (PFS) rate was 43% for auto-allo vs 21% for auto-auto. The 8-year overall survival rates were 55% and 50%, respectively. However, these findings were not statistically significant because fewer patients underwent auto-allo vs auto-auto, concludes Kröger. 

Nicolaus Kröger, MD, discusses the long-term results of a phase 2 study in multiple myeloma.  



Nicolaus Kröger, MD

Articles

Dr. Kröger on Toxicities Associated With Allogeneic Stem Cell Transplant in Myeloma

Dr. Kröger on the Role of Allogenic Stem Cell Transplant in Multiple Myeloma

Dr. Kröger on Long-Term Results With Tandem Transplant in Multiple Myeloma