title: Outcomes for reduced-intensity allogeneic transplantation for multiple myeloma: an analysis of prognostic factors from the Chronic Leukaemia Working Party of the EBMT.
abstract: We report the outcome of 229 patients who received an allograft for myeloma with reduced-intensity conditioning (RIC) regimens from 33 centers within the European Group for Blood and Marrow Transplantation (EBMT). The median age was 52 years and 64% were male. Conditioning regimens were heterogeneous, but most were fludarabine based and T cell depleted with antithymocyte globulin or alemtuzumab. Transplantation-related mortality (TRM) at 1 year was 22%. The 3-year overall survival (OS) and progression-free survival (PFS) were 41% and 21%, respectively. Adverse OS was associated with chemoresistant disease (relative risk [RR], 2.9), more than 1 prior transplantation (RR, 2.0), and male patients with female donors (RR, 1.45). Adverse PFS was associated with chemoresistance (RR, 2.4) and alemtuzumab (RR, 1.8). TRM was increased with female-to-male donation (RR, 2.5) and transplantation more than 1 year from diagnosis (RR, 2.3). Grades II to IV acute graft-versus-host disease (aGvHD) occurred in 31%. Chronic GvHD was associated with better OS and PFS and were 84% and 46% for limited, 58% and 30% for extensive, and 29% and 12% in its absence suggesting that a graft-versus-myeloma effect is important. While RIC is feasible, heavily pretreated patients and patients with progressive disease do not benefit.
authors.affiliation: Clinical Haematology, Box 234, Addenbrookes Hospital, Cambridge, CB2 2QQ, United Kingdom. charles.crawley@addenbrookes.nhs.uk
authors.forename: Charles
authors.initials: C
authors.lastname: Crawley
authors.forename: Marc
authors.initials: M
authors.lastname: Lalancette
authors.forename: Richard
authors.initials: R
authors.lastname: Szydlo
authors.forename: Maria
authors.initials: M
authors.lastname: Gilleece
authors.forename: Karl
authors.initials: K
authors.lastname: Peggs
authors.forename: Stephen
authors.initials: S
authors.lastname: Mackinnon
authors.forename: Gunnar
authors.initials: G
authors.lastname: Juliusson
authors.forename: Lucia
authors.initials: L
authors.lastname: Ahlberg
authors.forename: Arnon
authors.initials: A
authors.lastname: Nagler
authors.forename: Avichai
authors.initials: A
authors.lastname: Shimoni
authors.forename: Anna
authors.initials: A
authors.lastname: Sureda
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Boiron
authors.forename: Herman
authors.initials: H
authors.lastname: Einsele
authors.forename: Rajesh
authors.initials: R
authors.lastname: Chopra
authors.forename: Angelo
authors.initials: A
authors.lastname: Carella
authors.forename: Jamie
authors.initials: J
authors.lastname: Cavenagh
authors.forename: Alois
authors.initials: A
authors.lastname: Gratwohl
authors.forename: Frederic
authors.initials: F
authors.lastname: Garban
authors.forename: Axel
authors.initials: A
authors.lastname: Zander
authors.forename: Bo
authors.initials: B
authors.lastname: Björkstrand
authors.forename: Dietger
authors.initials: D
authors.lastname: Niederwieser
authors.forename: Gösta
authors.initials: G
authors.lastname: Gahrton
authors.forename: Jane F
authors.initials: JF
authors.lastname: Apperley
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D008212:Lymphocyte Depletion; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D014740:Vidarabine; C024352:fludarabine