Chronic but not acute graft-versus-host disease improves outcome in multiple myeloma patients after non-myeloablative allogeneic transplantation.
The outcome of 29 multiple myeloma patients receiving fludarabine and melphalan-based non-myeloablative allogeneic transplant (NMT) was evaluated. Event-free survival (EFS) at 24 months was 33%, being significantly higher for patients who developed chronic graft-versus-host disease (cGVHD) when compared with those who did not [51%vs 0% respectively, P = 0.02; hazard rate = 3.16 (95% confidence interval = 1.09-9.15, P = 0.03)] as well as for patients transplanted in complete remission/partial response (CR/PR) or stable disease (SD), compared with those with refractory/progressive disease (43%vs 0% respectively, P = 0.02). Overall survival (OS) at 24 months was 60%[72%vs 42% for patients who did and did not develop cGVHD respectively (P = 0.1); 63%vs 41% for patients in CR/PR or SD vs refractory/progressive disease at transplant respectively (P = 0.013)]. At a median follow-up of 366 d, 13 patients remained in CR/PR (45% overall response rate). Nine patients have died, three of them as a result of disease progression and six (21%) as a result of transplant-related mortality (TRM). Actuarial incidence of TRM was 37% for patients who developed acute GVHD vs 13% for those who did not (log rank, P = 0.04). The present study suggests that graft-versus-myeloma effect is the main weapon for disease control after NMT in MM patients and the efficacy of this immune effect depends on tumour burden before transplant.
Pérez-Simón
José A
JA
Hospital Clínico Universitario, Salamanca, Spain.
Martino
Rodrigo
R
Alegre
Adrián
A
Tomás
José F
JF
De Leon
Angel
A
Caballero
Dolores
D
Sureda
Ana
A
Sierra
Jordi
J
San Miguel
Jesús F
JF
D000208:Acute Disease; D000368:Aged; D016026:Bone Marrow Transplantation / Q000401:mortality; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000276:immunology* / Q000401:mortality / Q000628:therapy; D012044:Regression Analysis; D015996:Survival Rate; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome