Allogeneic marrow transplantation for multiple myeloma: an analysis of risk factors on outcome.
Between September 1987 and December 1994, 80 patients with multiple myeloma (MM) received high-dose busulfan and cyclophosphamide without (n = 57) or with modified total body irradiation (n = 23) followed by marrow from allogeneic donors. At transplant, 71% of the patients had disease that was refractory to chemotherapy. Thirty-five patients died of transplant-related causes within 100 days and 11 deaths occurred later. The actuarial probabilities of survival and progression-free survival were .24 +/- 0.17 and .20 +/- 0.10 at 4.5 years. Complete remissions were obtained in 36% of patients who had actuarial probabilities of survival and event-free survival of .50 +/- 0.21 and .43 +/- 0.17 at 4.5 years. In a multivariate analysis, adverse risk factors for outcome endpoints included: transplantation greater than 1 year from diagnosis; beta-2 microglobulin > 2.5 at transplant; female patients transplanted from male donors; patients who had received greater than eight cycles of chemotherapy before transplant and Durie stage 3 disease at the time of transplant. These results indicate that allografting for patients with MM can result in long-term disease-free survival for a minority of patients. Efforts to reduce transplant-related mortality should focus on earlier transplantation, less toxic treatment regimens, better supportive care, and improved prevention and treatment of graft-versus-host disease (GVHD).
Bensinger
W I
WI
Fred Hutchinson Cancer Research Center, Seattle, WA 98104, USA.
Buckner
C D
CD
Anasetti
C
C
Clift
R
R
Storb
R
R
Barnett
T
T
Chauncey
T
T
Shulman
H
H
Appelbaum
F R
FR
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000401:mortality; D002066:Busulfan; D003131:Combined Modality Therapy; D003520:Cyclophosphamide; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000628:therapy; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy*; D015999:Multivariate Analysis; D009363:Neoplasm Proteins / Q000032:analysis; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014916:Whole-Body Irradiation; D001613:beta 2-Microglobulin / Q000032:analysis
D009363:Neoplasm Proteins; D001613:beta 2-Microglobulin; D003520:Cyclophosphamide; D002066:Busulfan