title: Long-term follow-up of a comparison of nonmyeloablative allografting with autografting for newly diagnosed myeloma.
abstract: Before the introduction of new drugs, we designed a trial where treatment of newly diagnosed myeloma patients was based on the presence or absence of HLA-identical siblings. First-line treatments included a cytoreductive autograft followed by a nonmyeloablative allograft or a second melphalan-based autograft. Here, we report long-term clinical outcomes and discuss them in the light of the recent remarkable advancements in the treatment of myeloma. After a median follow-up of 7 years, median overall survival (OS) was not reached (P = .001) and event-free survival (EFS) was 2.8 years (P = .005) for 80 patients with HLA-identical siblings and 4.25 and 2.4 years for 82 without, respectively. Median OS was not reached (P = .02) and EFS was 39 months (P = .02) in the 58 patients who received a nonmyeloablative allograft whereas OS was 5.3 years and EFS 33 months in the 46 who received 2 high-dose melphalan autografts. Among patients who reached complete remission in these 2 cohorts, 53% and 19% are in continuous complete remission. Among relapsed patients rescued with "new drugs," median OS from the start of salvage therapy was not reached and was 1.7 (P = .01) years, respectively. Allografting conferred a long-term survival and disease-free advantage over standard autografting in this comparative study.
authors.affiliation: Division of Hematology, San Giovanni Battista Hospital, University of Torino, Via Genova 3, Turin, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Giaccone
authors.forename: Barry
authors.initials: B
authors.lastname: Storer
authors.forename: Francesca
authors.initials: F
authors.lastname: Patriarca
authors.forename: Marcello
authors.initials: M
authors.lastname: Rotta
authors.forename: Roberto
authors.initials: R
authors.lastname: Sorasio
authors.forename: Bernardino
authors.initials: B
authors.lastname: Allione
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Carnevale-Schianca
authors.forename: Moreno
authors.initials: M
authors.lastname: Festuccia
authors.forename: Lucia
authors.initials: L
authors.lastname: Brunello
authors.forename: Paola
authors.initials: P
authors.lastname: Omedè
authors.forename: Sara
authors.initials: S
authors.lastname: Bringhen
authors.forename: Massimo
authors.initials: M
authors.lastname: Aglietta
authors.forename: Alessandro
authors.initials: A
authors.lastname: Levis
authors.forename: Nicola
authors.initials: N
authors.lastname: Mordini
authors.forename: Andrea
authors.initials: A
authors.lastname: Gallamini
authors.forename: Renato
authors.initials: R
authors.lastname: Fanin
authors.forename: Massimo
authors.initials: M
authors.lastname: Massaia
authors.forename: Antonio
authors.initials: A
authors.lastname: Palumbo
authors.forename: Giovannino
authors.initials: G
authors.lastname: Ciccone
authors.forename: Rainer
authors.initials: R
authors.lastname: Storb
authors.forename: Ted A
authors.initials: TA
authors.lastname: Gooley
authors.forename: Mario
authors.initials: M
authors.lastname: Boccadoro
authors.forename: Benedetto
authors.initials: B
authors.lastname: Bruno
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D005260:Female; D005500:Follow-Up Studies; D006648:Histocompatibility / Q000502:physiology; D006801:Humans; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D020360:Neoadjuvant Therapy; D016879:Salvage Therapy; D035781:Siblings; D016019:Survival Analysis; D013997:Time Factors; D019172:Transplantation Conditioning / Q000379:methods; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
chemical_list: D019653:Myeloablative Agonists; D008558:Melphalan