Comparison of twin and autologous transplants for multiple myeloma.
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.
Bashey
Asad
A
BMT Group of Georgia, Atlanta, Georgia.
Pérez
Waleska S
WS
Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
Zhang
Mei-Jie
MJ
Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
Anderson
Kenneth C
KC
Dana-Farber Cancer Institute, Boston, Massachusetts.
Ballen
Karen
K
Massachusetts General Hospital, Boston, Massachusetts.
Berenson
James R
JR
Institute for Myeloma and Bone Cancer Research, West Hollywood, California.
To
L Bik
LB
Institute of Medical and Veterinary Science, Adelaide, Australia.
Fonseca
Rafael
R
Mayo Clinic Scottsdale, Scottsdale, Arizona.
Freytes
César O
CO
University of Texas Health Science Center, San Antonio, Texas.
Gale
Robert Peter
RP
Celgene Corporation, Summit, New Jersey.
Gibson
John
J
Royal Prince Alfred Hospital, Camperdown, Australia.
Giralt
Sergio A
SA
M.D. Anderson Cancer Center, Houston, Texas.
Kyle
Robert A
RA
Mayo Clinic Rochester, Rochester, Minnesota.
Lazarus
Hillard M
HM
University Hospitals Case Medical Center, Cleveland, Ohio.
Maharaj
Dipnarine
D
South Florida Bone Marrow Stem Cell Transplant Institute, Boynton Beach, Florida.
McCarthy
Philip L
PL
Roswell Park Cancer Institute, Buffalo, New York.
Milone
Gustavo A
GA
FUNDALEU, Buenos Aires, Argentina.
Nimer
Stephen
S
Memorial Sloan-Kettering Cancer Center, New York, New York.
Pavlovsky
Santiago
S
FUNDALEU, Buenos Aires, Argentina.
Reece
Donna E
DE
Princess Margaret Hospital, Toronto, Ontario, Canada.
Schiller
Gary
G
University of California, Los Angeles, Los Angeles, California.
Vesole
David H
DH
St. Vincent's Comprehensive Cancer Center, New York, New York.
Hari
Parameswaran
P
Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: phari@mcw.edu.
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