title: Unrelated stem cell transplantation after reduced intensity conditioning for patients with multiple myeloma relapsing after autologous transplantation.
abstract: From 2002 to 2007, 49 myeloma patients who relapsed following autologous SCT were included in a prospective multicenter trial to determine the efficacy of a reduced melphalan/fludarabine regimen followed by allogeneic SCT from unrelated donors. All patients showed leucocyte and platelet engraftment after a median of 15 and 19 d, respectively. Grade II-IV acute graft-versus-host disease (GvHD) occurred in 25% of patients and 35% had chronic GvHD. Overall response rate at day 100 was 95% including 46% complete remission (CR). Cumulative incidence of non-relapse mortality at 1 year was 25% [95% confidence interval (CI): 13-37%] and was significantly lower for human leucocyte antigen (HLA)-matched compared to -mismatched SCT (10% vs. 53%, P = 0.001). The cumulative incidence of relapse at 3 years was 55% (95% CI: 40-70%). After a median follow up of 43 months, the estimated 5-year progression-free and overall survival rates were 20% and 26% respectively and were significantly better for matched in CR at day 100 (41% vs. 7%, P = 0.04 and 56% vs. 16%, P = 0.02). We conclude that optimal donor selection is mandatory for a low non-relapse mortality and high relapse incidence, which remains a major concern, should be improved by including post-transplant strategies to upgrade remission status.
authors.affiliation: University Hospital Hamburg-Eppendorf, Germany. nkroeger@uke.uni-hamburg.de
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Kröger
authors.forename: Avichai
authors.initials: A
authors.lastname: Shimoni
authors.forename: Georgia
authors.initials: G
authors.lastname: Schilling
authors.forename: Rainer
authors.initials: R
authors.lastname: Schwerdtfeger
authors.forename: Martin
authors.initials: M
authors.lastname: Bornhäuser
authors.forename: Arnon
authors.initials: A
authors.lastname: Nagler
authors.forename: Axel R
authors.initials: AR
authors.lastname: Zander
authors.forename: Marion
authors.initials: M
authors.lastname: Heinzelmann
authors.forename: Ronald
authors.initials: R
authors.lastname: Brand
authors.forename: Gösta
authors.initials: G
authors.lastname: Gahrton
authors.forename: Curly
authors.initials: C
authors.lastname: Morris
authors.forename: Dietger
authors.initials: D
authors.lastname: Niederwieser
authors.forename: Theo
authors.initials: T
authors.lastname: de Witte
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D006801:Humans; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D012008:Recurrence; D033581:Stem Cell Transplantation; D016019:Survival Analysis; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D014740:Vidarabine; C024352:fludarabine; D008558:Melphalan