Post-transplant immunotherapy with donor-lymphocyte infusion and novel agents to upgrade partial into complete and molecular remission in allografted patients with multiple myeloma.
OBJECTIVE
To investigate post-transplant immunotherapy with escalating donor-lymphocyte infusions (DLI) and novel agents (thalidomide, bortezomib, and lenalidomide) to target complete remission (CR).


METHODS
Thirty-two patients with multiple myeloma who achieved only partial remission after allogeneic stem cell transplantation were treated with DLI. If no CR was achieved, one of the novel agents was added to target CR.


RESULTS
CR defined either by European Group for Blood and Marrow Transplantation criteria, flow cytometry, or molecular methods as assessed by patient-specific immunoglobulin H-polymerase chain reaction or plasma cell chimerism polymerase chain reaction was accomplished in 59%, 63%, and 50% of patients, respectively. Achievement of CR resulted in improved 5-year progressive-free and overall survival, according to European Group for Blood and Marrow Transplantation criteria (53% vs 35%; p=0.03 and 90% vs 62%; p=0.06), flow cytometry (74% vs 15%; p=0.001 and 100% vs 52%; p=0.1), or molecular methods (84% vs 38%; p=0.001 and 100% vs 71%; p=0.03).


CONCLUSIONS
Our finding demonstrates the clinical relevance of posttransplantation therapies to upgrade remission, and of remission's depth for long-term survival in myeloma patients.
Kröger
Nicolaus
N
Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. nkroeger@uke.uni-hamburg.de
Badbaran
Anita
A
Lioznov
Michael
M
Schwarz
Sabine
S
Zeschke
Silke
S
Hildebrand
York
Y
Ayuk
Francis
F
Atanackovic
Djordje
D
Schilling
Georgia
G
Zabelina
Tatjana
T
Bacher
Ulrike
U
Klyuchnikov
Evgeny
E
Shimoni
Avichai
A
Nagler
Arnon
A
Corradini
Paolo
P
Fehse
Boris
B
Zander
Axel
A
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017690:Cell Transplantation; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007167:Immunotherapy; D008214:Lymphocytes / Q000166:cytology*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000628:therapy*; D012074:Remission Induction; D033581:Stem Cell Transplantation; D016019:Survival Analysis; D014184:Transplantation, Homologous
D000970:Antineoplastic Agents