title: Reduced-intensity allogeneic hematopoietic stem cell transplantation for relapsed multiple myeloma.
abstract: Despite recent advances, multiple myeloma (MM) remains incurable, and most patients eventually develop progressive disease. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) offers a potentially curative option in 10%-20% of patients with relapsed or refractory disease. We evaluated the outcome of patients undergoing allo-HSCT with reduced-intensity conditioning (RIC) for relapsed and/or refractory MM at our institution. The study cohort included 51 patients with heavily pretreated, relapsed MM who underwent RIC allo-HSCT between 1996 and 2006. The median time from diagnosis to allo-HSCT was 34 months, and median follow-up in surviving patients was 27 months (range, 3-98 months). Cumulative transplantation-related mortality at 1 year was 25%. Progression-free survival (PFS) and overall survival (OS) at 2 years were 19% and 32%, respectively. The incidences of grade II-IV acute and chronic graft-versus-host disease were 27% and 47%, respectively. At the time of this analysis, 12 patients (24%) were alive, 7 of whom (14%) were in remission for up to 6 years after allo-HSCT. A lower beta2 microglobulin level (<3.3) and previous autologous HSCT were predictive of lower nonrelapse mortality and longer PFS and OS. Our findings indicate that allo-HSCT with RIC is associated with acceptable toxicity and durable remission and survival in relapsed or refractory MM. The use of RIC allo-HSCT earlier in the course of the disease may offer the greatest benefit.
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Yvonne A
authors.initials: YA
authors.lastname: Efebera
authors.forename: Sofia R
authors.initials: SR
authors.lastname: Qureshi
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Cole
authors.forename: Rima
authors.initials: R
authors.lastname: Saliba
authors.forename: Matteo
authors.initials: M
authors.lastname: Pelosini
authors.forename: Ronak M
authors.initials: RM
authors.lastname: Patel
authors.forename: Ebru
authors.initials: E
authors.lastname: Koca
authors.forename: Floralyn L
authors.initials: FL
authors.lastname: Mendoza
authors.forename: Michael
authors.initials: M
authors.lastname: Wang
authors.forename: Jatin
authors.initials: J
authors.lastname: Shah
authors.forename: Amin
authors.initials: A
authors.lastname: Alousi
authors.forename: Chitra
authors.initials: C
authors.lastname: Hosing
authors.forename: Uday
authors.initials: U
authors.lastname: Popat
authors.forename: Partow
authors.initials: P
authors.lastname: Kebriaei
authors.forename: Paolo
authors.initials: P
authors.lastname: Anderlini
authors.forename: Issa F
authors.initials: IF
authors.lastname: Khouri
authors.forename: Richard
authors.initials: R
authors.lastname: Champlin
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
authors.forename: Muzaffar H
authors.initials: MH
authors.lastname: Qazilbash
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy*; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D011379:Prognosis; D019172:Transplantation Conditioning; D016896:Treatment Outcome