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<p>Autologous stem cell transplantation (auto-SCT) remains an important pillar in multiple myeloma (MM) therapy; however, there is an increased risk of developing second primary malignancy including second hematological malignancy (SHM). We performed a retrospective study of patients with MM who underwent an auto-SCT at our institution between 1990 and 2022 and subsequently developed SHM. Among 3401 patients with MM who underwent auto-SCT, 110 (3.2%) developed SHM [therapy related myeloid neoplasm (t-MN) = 98; acute B cell lymphoblastic leukemia (t-B-ALL) = 11 and mixed phenotype acute leukemia=1). The cumulative incidence of SHM has increased between the pre-novel (auto-SCT, 1990–2006) and novel agent eras (2007- 2022) (1.1% vs 2.0% at 60 months; <i>P</i> = 0.03). Somatic mutations in <i>TP 53</i> gene were seen in 40% of patients with t-MN. Among t-B-ALL patients, high incidence of hypodiploidy (<i>n</i> = 4) and <i>IKZF1</i> (<i>n</i> = 3) deletion was observed. In multivariate analysis, receiving an alkylator based induction, radiation therapy, achieving a complete response after auto-SCT, use of cyclophosphamide for stem cell mobilization and lenalidomide maintenance were independent predictors of developing SHM. Patients with MM who developed a SHM had an inferior overall survival (OS). Given the median OS for MM continues to improve, monitoring for SHM and risk mitigation strategies is crucial.</p>

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Characteristics and outcomes of secondary hematological malignancies following autologous stem cell transplantation for multiple myeloma

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月23日

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  • Binoy Yohannan,
  • Benjamin W. Langworthy,
  • Lindsey E. Turner,
  • Angela Dispenzieri,
  • Francis K. Buadi,
  • David Dingli,
  • Nelson Leung,
  • Prashant Kapoor,
  • Wilson I. Gonsalves,
  • Taxiarchis Kourelis,
  • Joselle Cook,
  • Moritz Binder,
  • Suzanne R. Hayman,
  • Yi Lin,
  • Ronald S. Go,
  • Rahma M. Warsame,
  • S.Vincent Rajkumar,
  • Shaji Kumar,
  • Eli Muchtar,
  • Hassan B. Alkhateeb,
  • William J. Hogan,
  • Aasiya Matin,
  • Mrinal M. Patnaik,
  • Aref Al-Kali,
  • Abhishek A. Mangaonkar,
  • Hefazi Torghabeh M,
  • Robert C. Wolf,
  • Mithun V. Shah,
  • Morie A. Gertz

摘要

Autologous stem cell transplantation (auto-SCT) remains an important pillar in multiple myeloma (MM) therapy; however, there is an increased risk of developing second primary malignancy including second hematological malignancy (SHM). We performed a retrospective study of patients with MM who underwent an auto-SCT at our institution between 1990 and 2022 and subsequently developed SHM. Among 3401 patients with MM who underwent auto-SCT, 110 (3.2%) developed SHM [therapy related myeloid neoplasm (t-MN) = 98; acute B cell lymphoblastic leukemia (t-B-ALL) = 11 and mixed phenotype acute leukemia=1). The cumulative incidence of SHM has increased between the pre-novel (auto-SCT, 1990–2006) and novel agent eras (2007- 2022) (1.1% vs 2.0% at 60 months; P = 0.03). Somatic mutations in TP 53 gene were seen in 40% of patients with t-MN. Among t-B-ALL patients, high incidence of hypodiploidy (n = 4) and IKZF1 (n = 3) deletion was observed. In multivariate analysis, receiving an alkylator based induction, radiation therapy, achieving a complete response after auto-SCT, use of cyclophosphamide for stem cell mobilization and lenalidomide maintenance were independent predictors of developing SHM. Patients with MM who developed a SHM had an inferior overall survival (OS). Given the median OS for MM continues to improve, monitoring for SHM and risk mitigation strategies is crucial.