Clonal cytogenetic changes and myeloma relapse after reduced intensity conditioning allogeneic transplantation.
To identify a correlation between metaphase cytogenetics and relapse after reduced intensity conditioning (RIC) allotransplant for patients with multiple myeloma, data on 60 patients (median age 52) who received grafts from a sibling (n = 49) or unrelated donor (n = 11) were analyzed. Fifty-three patients (88%) showed chromosomal abnormalities (CA) before the allotransplant, including 42 with abnormalities involving 13q (CA13). Twenty-two patients (41%) relapsed post-allotransplant at a median of 165 days. Of these, 11 patients showed abnormal cytogenetics at the time of post-allotransplant relapse at a median of 167 days. Of 54 patients who developed graft-versus-host disease, relapse occurred in 19 of 48 patients (43%) with CA present before RCI allotransplant, versus 1 of 6 without CA (17%) (P = 0.06). Loss of CA before RIC allotransplant and disease status > PR after RIC allotransplant were significantly associated with a lower risk of post-allotransplant relapse with cytogenetic abnormalities; 5.2 vs 36%, and 18 vs 53%, (both P < 0.05), respectively. The current data suggests that myeloma associated with persistent clonal cytogenetic abnormalities is an entity which most likely escapes the effects of a graft versus myeloma activity, maybe because of acquisition of resistance to immunologic manipulations.
Lee
C-K
CK
The Myeloma Institute for Research and Therapy, The University of Arkansas for Medical Sciences, Little Rock, AR, USA. cholee@umich.edu
Zangari
M
M
Fassas
A
A
Thertulien
R
R
Talamo
G
G
Badros
A
A
Cottler-Fox
M
M
van Rhee
F
F
Barlogie
B
B
Tricot
G
G
D000328:Adult; D000368:Aged; D002869:Chromosome Aberrations; D002999:Clone Cells / Q000473:pathology; D005260:Female; D020350:Graft vs Tumor Effect / Q000235:genetics; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D008297:Male; D008677:Metaphase; D008875:Middle Aged; D009101:Multiple Myeloma / Q000235:genetics* / Q000473:pathology / Q000628:therapy*; D012008:Recurrence; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D019139:Tumor Escape / Q000235:genetics*