title: Comparison of twin and autologous transplants for multiple myeloma.
abstract: Relapse is the overwhelming cause of treatment failure after autologous transplantation for multiple myeloma (MM). For patients with a syngeneic donor, twin transplants provide a healthy graft that is free of myeloma. The relative impact of the graft on posttransplant relapse can be estimated by comparing risk of relapse after hematopoietic cell transplantation from genetically identical twins versus autotransplants because confounding differences in minor or major histocompatibility antigens are absent in the syngeneic transplant setting. Outcomes of 43 subjects who received twin transplants for MM were compared to 170 matched autotransplant recipients reported to the Center for International Blood and Marrow Transplant Research (CIBMTR). Multivariate analysis was performed by fitting a Cox model stratified on matched pairs. The matched transplant patients studied were similar with respect to subject-, disease-, and transplant-related characteristics. Cumulative incidence of relapse/progression was significantly lower, and progression-free survival (PFS) was significantly higher following twin transplants. In multivariate analysis, the probability of relapse/progression was lower in twins (relative risk [RR] = 0.49, 95% confidence interval [CI] 0.28-0.86, P = .011). Twin transplants have a significantly lower relapse risk than autotransplants in MM, suggesting that graft composition may impact outcomes following high-dose chemotherapy.
authors.affiliation: BMT Group of Georgia, Atlanta, Georgia.
authors.forename: Asad
authors.initials: A
authors.lastname: Bashey
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Waleska S
authors.initials: WS
authors.lastname: Pérez
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Mei-Jie
authors.initials: MJ
authors.lastname: Zhang
authors.affiliation: Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Anderson
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Karen
authors.initials: K
authors.lastname: Ballen
authors.affiliation: Institute for Myeloma and Bone Cancer Research, West Hollywood, California.
authors.forename: James R
authors.initials: JR
authors.lastname: Berenson
authors.affiliation: Institute of Medical and Veterinary Science, Adelaide, Australia.
authors.forename: L Bik
authors.initials: LB
authors.lastname: To
authors.affiliation: Mayo Clinic Scottsdale, Scottsdale, Arizona.
authors.forename: Rafael
authors.initials: R
authors.lastname: Fonseca
authors.affiliation: University of Texas Health Science Center, San Antonio, Texas.
authors.forename: César O
authors.initials: CO
authors.lastname: Freytes
authors.affiliation: Celgene Corporation, Summit, New Jersey.
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.affiliation: Royal Prince Alfred Hospital, Camperdown, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Gibson
authors.affiliation: M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Giralt
authors.affiliation: Mayo Clinic Rochester, Rochester, Minnesota.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kyle
authors.affiliation: University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.affiliation: South Florida Bone Marrow Stem Cell Transplant Institute, Boynton Beach, Florida.
authors.forename: Dipnarine
authors.initials: D
authors.lastname: Maharaj
authors.affiliation: Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Philip L
authors.initials: PL
authors.lastname: McCarthy
authors.affiliation: FUNDALEU, Buenos Aires, Argentina.
authors.forename: Gustavo A
authors.initials: GA
authors.lastname: Milone
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Stephen
authors.initials: S
authors.lastname: Nimer
authors.affiliation: FUNDALEU, Buenos Aires, Argentina.
authors.forename: Santiago
authors.initials: S
authors.lastname: Pavlovsky
authors.affiliation: Princess Margaret Hospital, Toronto, Ontario, Canada.
authors.forename: Donna E
authors.initials: DE
authors.lastname: Reece
authors.affiliation: University of California, Los Angeles, Los Angeles, California.
authors.forename: Gary
authors.initials: G
authors.lastname: Schiller
authors.affiliation: St. Vincent's Comprehensive Cancer Center, New York, New York.
authors.forename: David H
authors.initials: DH
authors.lastname: Vesole
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: phari@mcw.edu.
authors.forename: Parameswaran
authors.initials: P
authors.lastname: Hari
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy*; D012008:Recurrence; D014181:Transplantation Immunology; D014182:Transplantation, Autologous / Q000276:immunology; D014185:Transplantation, Isogeneic / Q000276:immunology; D014430:Twins, Monozygotic