Novel Agents Increased Risk for Engraftment Syndrome in Older Myeloma Patients

Older patients with multiple myeloma who were exposed to certain novel immunomodulatory agents prior to undergoing autologous peripheral blood stem cell transplantation were at an increased risk for engraftment syndrome compared with patients with lymphoma, according to a study recently published in Biology of Blood and Marrow Transplantation.

Ball-and-stick model of the proteasome inhibitor bortezomib

The researchers, led by William R. Drobyski, MD, professor of medicine and pediatrics and the Medical College of Wisconsin, found that the risk for this sometimes fatal complication was significant among patients with myeloma aged 60 years or older.

“There appears to be an increasing incidence of [engraftment syndrome] and it can, on occasion, result in mortality and can more frequently cause morbidity for patients,” Drobyski said. “Typically, it occurs toward the end of the patient’s hospital course when they are preparing to go home and can delay their discharge if symptoms are significant.”

The researchers conducted a retrospective analysis of the records of 591 patients with myeloma (71%) or lymphoma. All patients had undergone consecutive transplantations at the Medical College of Wisconsin between 2001 and 2010. Patients were followed for a mean of 49 months.

Twenty-two percent of the patients developed engraftment syndrome. A higher percentage of patients with myeloma (27%) developed the condition compared with patients with non-Hodgkin lymphoma (12%) or Hodgkin lymphoma (6%).

After conducting a multivariate analysis, the researchers found that both age older than 60 years (HR = 1.71; 95% CI, 1.12–2.62) and having a transplantation for multiple myeloma (HR = 2.80; 95% CI, 1.60–4.90) increased risk for engraftment syndrome.

Next, Drobyski and colleagues isolated the data to only those patients with multiple myeloma and found that exposure to therapeutic agents prior to transplantation affected the results. In addition to age older than 60 years, prior treatment with lenalidomide and bortezomib increased risk for engraftment syndrome (HR = 1.82; 95% CI, 1.11–3.04); however, those patients who had prior exposure to cyclophosphamide had a significantly lower incidence.

“As newer, more potent immune modulatory agents are used to treat these patients, this may inadvertently result in an increased incidence and possibly severity of this syndrome in those patients,” Drobyski told Cancer Network. “We believe that clinicians caring for these patients need to be cognizant of this complication and risk factors associated with it.”