Allogeneic Hematopoietic Cell Transplantation in Multiple Myeloma: Focus on Longitudinal Assessment of Donor Chimerism, Extramedullary Disease, and High-Risk.

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Allogeneic Hematopoietic Cell Transplantation in Multiple Myeloma: Focus on Longitudinal Assessment of Donor Chimerism, Extramedullary Disease, and High-Risk Cytogenetic Features Leo Rasche, Christoph Röllig, Gernot Stuhler, Sophia Danhof, Stephan Mielke, Goetz Ulrich Grigoleit, Lea Dissen, Lea Schemmel, Jan Moritz Middeke, Viktoria Rücker, Martin Schreder, Johannes Schetelig, Martin Bornhäuser, Hermann Einsele, Christian Thiede, Stefan Knop Biology of Blood and Marrow Transplantation Volume 22, Issue 11, Pages 1988-1996 (November 2016) DOI: 10.1016/j.bbmt.2016.08.024 Copyright © 2016 The American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 1 Donor chimerism analysis. (A) Engraftment within the first 30 days. (B) DC drops from day 30-2000. (C) DC drops in PB of patients in remission for MM. A case associated with Epstein-Barr virus triggered lymphoproliferative disease (PTLD) presenting with leukemic pattern, and another case was associated with acute GVHD. (D) DC drops in PB in relapsed patients. (E) DC drops in BM. (F) DC status at the time point of relapse as defined by the International Myeloma Working Group criteria. Biology of Blood and Marrow Transplantation 2016 22, 1988-1996DOI: (10.1016/j.bbmt.2016.08.024) Copyright © 2016 The American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 2 Extramedullary disease. (A) Relapse pattern after allo-SCT. (B) Sites with extramedullary involvement. Biology of Blood and Marrow Transplantation 2016 22, 1988-1996DOI: (10.1016/j.bbmt.2016.08.024) Copyright © 2016 The American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 3 Factors influencing survival after allo-SCT. (A) Impact of lines of therapy before allo-SCT. (B) Impact of remission status before allo-SCT. (C) History of EMD allo-SCT. (D) Impact of cytogenetic aberrations on outcome. Biology of Blood and Marrow Transplantation 2016 22, 1988-1996DOI: (10.1016/j.bbmt.2016.08.024) Copyright © 2016 The American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 4 Landmark analysis (6 months after allo-SCT) of time-dependent variables. (A) Impact of cGVHD on PFS and OS. (B) Impact of preemptive DLI on PFS and OS. Biology of Blood and Marrow Transplantation 2016 22, 1988-1996DOI: (10.1016/j.bbmt.2016.08.024) Copyright © 2016 The American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 5 Multivariable analysis: Forrest plot shows hazard ratios and 95% confidence intervals (CI) for PFS (A) and OS (B). Reference category for remission state was CR/VGPR before allo-SCT, whereas for first and second relapse it was allo-SCT at initial diagnosis, no signs of EMD for proven extramedullary involvement, and full DC to “loss of full DC,” respectively. Biology of Blood and Marrow Transplantation 2016 22, 1988-1996DOI: (10.1016/j.bbmt.2016.08.024) Copyright © 2016 The American Society for Blood and Marrow Transplantation Terms and Conditions