Reduced-intensity allogeneic hematopoietic stem cell transplantation for relapsed multiple myeloma.
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.
Efebera
Yvonne A
YA
Department of Stem Cell Transplantation and Cellular Therapy, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
Qureshi
Sofia R
SR
Cole
Suzanne M
SM
Saliba
Rima
R
Pelosini
Matteo
M
Patel
Ronak M
RM
Koca
Ebru
E
Mendoza
Floralyn L
FL
Wang
Michael
M
Shah
Jatin
J
Alousi
Amin
A
Hosing
Chitra
C
Popat
Uday
U
Kebriaei
Partow
P
Anderlini
Paolo
P
Khouri
Issa F
IF
Champlin
Richard
R
Giralt
Sergio
S
Qazilbash
Muzaffar H
MH
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