ASTCT Clinical Practice Recommendations for Transplantation and Cellular Therapies in Multiple Myeloma

Binod Dhakal, Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin.
Nina Shah, Division of Hematology-Oncology, University of California, San Francisco, California.
Ankit Kansagra, Department of Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
Ambuj Kumar, Program for Comparative Effectiveness Research, University of South Florida Morsani College of Medicine, Tampa, Florida.
Sagar Lonial, Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia.
Alfred Garfall, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Andrew Cowan, University of Washington, Seattle WA, and Fred Hutch, Seattle, Washington.
Bishesh Sharma Poudyal, Department of Clinical Hematology and Bone Marrow Transplant, Civil Service Hospital, Kathmandu, Nepal.
Caitlin Costello, UCSD/Sharp Healthcare Transplant Program, Blood & Marrow Transplant Services, Moore's Cancer Center, San-Diego, California.
Francesca Gay, Division of Hematology 1 Clinical Trial Unit, AOU CIttà della salute e della Scienza, University of Torino, Turin, Italy.
Gordon Cook, Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trial Research, University of Leeds, Leeds, United Kingdom.
Hang Quach, University of Melbourne, St. Vincent's Hospital, Melbourne, Australia.
Herman Einsele, Universitätsklinikum Würzburg, Department of Internal Medicine II, Würzburg, Germany.
Jeff Schriber, Cancer Treatment Centers of America, Phoenix, Arizona.
Jian Hou, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Luciano Costa, Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, Alabama.
Mahmoud Aljurf, Oncology Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
Maria Chaudhry, Department of hematology/Oncology, George Washington University and Cancer Center, Washington, District of Columbia.
Meral Beksac, Department of Hematology, Ankara University, Ankara, Turkey.
Miles Prince, Epworth Healthcare and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
Mohamad Mohty, Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France.
Murali Janakiram, Division of Myeloma, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, California.
Natalie Callander, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin.
Noa Biran, Hackensack Meridian Health, John Theurer Cancer Center, Multiple Myeloma Division, Hackensack, New Jersey.
Pankaj Malhotra, Department of Clinical Hematology & Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Paula Rodriguez Otero, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
Philippe Moreau, Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France.
Rafat Abonour, Indiana University School of Medicine, Indianapolis, Indiana.
Raheel Iftikhar, Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan.
Rebecca Silberman, Department of Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon.
Sham Mailankody, Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New, York, New York.
Tara Gregory, Colorado Blood Cancer Institute, Sarah Cannon Cancer Network, Denver, Colorado.

Document Type

Journal Article

Publication Date

6-1-2022

Journal

Transplantation and cellular therapy

Volume

28

Issue

6

DOI

10.1016/j.jtct.2022.03.019

Keywords

Allogeneic transplantation; Autologous transplantation; CAR T-cells; Cellular therapy; Consensus; Multiple myeloma

Abstract

Over the past decade, therapeutic options in multiple myeloma (MM) have changed dramatically. Given the unprecedented efficacy of novel agents, the role of hematopoietic cell transplantation (HCT) in MM remains under scrutiny. Rapid advances in myeloma immunotherapy including the recent approval of chimeric antigen receptor (CAR) T-cell therapy will impact the MM therapeutic landscape. The American Society for Transplantation and Cellular Therapy convened an expert panel to formulate clinical practice recommendations for role, timing, and sequencing of autologous (auto-HCT), allogeneic (allo-HCT) and CAR T-cell therapy for patients with newly diagnosed (NDMM) and relapsed/refractory MM (RRMM). The RAND-modified Delphi method was used to generate consensus statements. Twenty consensus statements were generated. The panel endorsed continued use of auto-HCT consolidation for patients with NDMM as a standard-of-care option, whereas in the front line allo-HCT and CAR-T were not recommended outside the setting of clinical trial. For patients not undergoing auto-HCT upfront, the panel recommended its use in first relapse. Lenalidomide as a single agent was recommended for maintenance especially for standard risk patients. In the RRMM setting, the panel recommended the use of CAR-T in patients with 4 or more prior lines of therapy. The panel encouraged allo-HCT in RRMM setting only in the context of clinical trial. The panel found RAND-modified Delphi methodology effective in providing a formal framework for developing consensus recommendations for the timing and sequence of cellular therapies for MM.

Department

Medicine

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