Many patients with multiple myeloma (MM) eventually relapse even after allogeneic hematopoietic cell transplantation (alloHCT) for curative intent. Over the past decade, outcomes for patients with MM have improved significantly with the availability of new therapies, including next-generation proteasome inhibitors, immunomodulatory agents, and, more recently, monoclonal antibodies. Although several published studies have evaluated the outcomes of alloHCT for MM, the data on survival outcomes in patients with MM experiencing disease relapse following alloHCT are limited. In addition, the predictors for postrelapse survival in these patients are not known. In this study, we examined the outcomes of a single-center cohort of 60 patients with MM who experienced relapse or progression after alloHCT. In addition, we evaluated the use of salvage regimens for treatment of relapsed MM and analyzed the predictors for improved postrelapse survival. After a median follow-up of 2.2 years from the time of relapse, the median duration of postrelapse survival was 1.8 years (95% confidence interval [CI], 1.2 to 5.0 years). Patients received a median of 3 lines of therapy (range, 0 to 10) for treatment of MM beyond the post-alloHCT relapse/progression. Multivariate analysis identified cytogenetic risk (standard risk versus high risk; hazard ratio [HR], .34; P = .01), time to relapse after alloHCT (>12 months versus ≤12 months: HR, .41; P = .04), and occurrence of acute graft-versus-host disease (GVHD) before relapse (GVHD versus no GVHD: HR, 2.89; P = .01) significantly affected postrelapse survival. These data illustrate that long-term myeloma control and survival is attainable in those relapsing/progressing after alloHCT and suggest that the synergism between novel therapies and the allogeneic immune platform is the key to improved survival in this high-risk patient population.

许多具有多发性骨髓瘤（MM）的患者最终甚至在同种异体造血细胞移植（alloHCT）达到治愈目的后复发。在过去的十年中，随着新疗法的出现，包括下一代蛋白酶体抑制剂，免疫调节剂以及最近的单克隆抗体，MM患者的预后得到了显着改善。尽管一些已发表的研究评估了alloHCT对MM的预后，但是在alloHCT之后经历疾病复发的MM患者的生存预后数据仍然有限。另外，这些患者中复发后存活的预测因子尚不清楚。在这项研究中，我们检查了60名MM患者在alloHCT后经历复发或进展的单中心队列的结局。此外，我们评估了挽救方案治疗复发性MM的使用，并分析了改善复发后生存率的预测指标。从复发时间开始进行中位随访2.2年后，中位复发后生存时间为1.8年（95％置信区间[CI]为1.2至5.0年）。在alloHCT后复发/进展后，患者接受了3种中线MM治疗（0至10范围）。多变量分析确定了细胞遗传学风险（标准风险与高风险；危险比[HR] ，. 34； P = .01），alloHCT后复发时间（> 12个月对≤12个月：HR，.41；8年（95％置信区间[CI]为1.2至5.0年）。在alloHCT后复发/进展后，患者接受了3种中线MM治疗（0至10范围）。多变量分析确定了细胞遗传学风险（标准风险与高风险；危险比[HR] ，. 34； P = .01），alloHCT后复发时间（> 12个月对≤12个月：HR，.41；8年（95％置信区间[CI]为1.2至5.0年）。在alloHCT后复发/进展后，患者接受了3种中线MM治疗（0至10范围）。多变量分析确定了细胞遗传学风险（标准风险与高风险；危险比[HR] ，. 34； P = .01），alloHCT后复发时间（> 12个月对≤12个月：HR，.41；P  = .04），以及复发前发生急性移植物抗宿主病（GVHD与无GVHD：HR，2.89；P  = .01）显着影响复发后生存。这些数据表明，在同种异体移植后复发/进展的患者中，长期骨髓瘤控制和生存是可以实现的，并且表明新疗法与同种异体免疫平台之间的协同作用是提高高危患者群体生存的关键。