title: Nonmyeloablative allografting for newly diagnosed multiple myeloma: the experience of the Gruppo Italiano Trapianti di Midollo.
abstract: Despite recent advances, allografting remains the only potential cure for myeloma. From July 1999 to June 2005, 100 newly diagnosed patients younger than 65 years were enrolled in a prospective multicenter study. First-line treatment included vincristin, adriamycin, and dexamethasone (VAD)-based induction chemotherapy, a cytoreductive autograft (melphalan 200 mg/m(2)) followed by a single dose of nonmyeloablative total body irradiation and allografting from an human leukocyte antigen (HLA)-identical sibling. Primary end points were the overall survival (OS) and event-free survival (EFS) from diagnosis. After a median follow-up of 5 years, OS was not reached, and EFS was 37 months. Incidences of acute and chronic graft-versus-host disease (GVHD) were 38% and 50%, respectively. Complete remission (CR) was achieved in 53% of patients. Profound cytoreduction (CR or very good partial remission) before allografting was associated with achievement of posttransplantation CR (hazard ratio [HR] 2.20, P = .03) and longer EFS (HR 0.33, P < .01). Conversely, development of chronic GVHD was not correlated with CR or response duration. This tandem transplantation approach allows prolonged survival and long-term disease control in patients with reduced tumor burden at the time of allografting. We are currently investigating the role of "new drugs" in intensifying pretransplantation cytoreduction and posttransplantation graft-versus-myeloma effects to further improve clinical outcomes. (http://ClinicalTrials.gov; NCT-00702247.).
authors.affiliation: Division of Hematology, S Giovanni Battista Hospital, University of Torino, Torino, Italy. benedetto.bruno@unito.it
authors.forename: Benedetto
authors.initials: B
authors.lastname: Bruno
authors.forename: Marcello
authors.initials: M
authors.lastname: Rotta
authors.forename: Francesca
authors.initials: F
authors.lastname: Patriarca
authors.forename: Daniele
authors.initials: D
authors.lastname: Mattei
authors.forename: Bernardino
authors.initials: B
authors.lastname: Allione
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Carnevale-Schianca
authors.forename: Roberto
authors.initials: R
authors.lastname: Sorasio
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rambaldi
authors.forename: Marco
authors.initials: M
authors.lastname: Casini
authors.forename: Matteo
authors.initials: M
authors.lastname: Parma
authors.forename: Pasqua
authors.initials: P
authors.lastname: Bavaro
authors.forename: Francesco
authors.initials: F
authors.lastname: Onida
authors.forename: Alessandro
authors.initials: A
authors.lastname: Busca
authors.forename: Luca
authors.initials: L
authors.lastname: Castagna
authors.forename: Edoardo
authors.initials: E
authors.lastname: Benedetti
authors.forename: Anna Paola
authors.initials: AP
authors.lastname: Iori
authors.forename: Luisa
authors.initials: L
authors.lastname: Giaccone
authors.forename: Antonio
authors.initials: A
authors.lastname: Palumbo
authors.forename: Paolo
authors.initials: P
authors.lastname: Corradini
authors.forename: Renato
authors.initials: R
authors.lastname: Fanin
authors.forename: David
authors.initials: D
authors.lastname: Maloney
authors.forename: Rainer
authors.initials: R
authors.lastname: Storb
authors.forename: Ileana
authors.initials: I
authors.lastname: Baldi
authors.forename: Umberto
authors.initials: U
authors.lastname: Ricardi
authors.forename: Mario
authors.initials: M
authors.lastname: Boccadoro
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D016879:Salvage Therapy; D016019:Survival Analysis; D013997:Time Factors; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous / Q000379:methods; D016896:Treatment Outcome