title: Trends in allogeneic stem cell transplantation for multiple myeloma: a CIBMTR analysis.
abstract: Allogeneic hematopoietic cell transplantation in multiple myeloma is limited by prior reports of high treatment-related mortality. We analyzed outcomes after allogeneic hematopoietic cell transplantation for multiple myeloma in 1207 recipients in 3 cohorts based on the year of transplantation: 1989-1994 (n = 343), 1995-2000 (n = 376), and 2001-2005 (n = 488). The most recent cohort was significantly older (53% > 50 years) and had more recipients after prior autotransplantation. Use of unrelated donors, reduced-intensity conditioning and the blood cell grafts increased over time. Rates of acute graft-versus-host (GVHD) were similar, but chronic GVHD rates were highest in the most recent cohort. Overall survival (OS) at 1-year increased over time, reflecting a decrease in treatment-related mortality, but 5-year relapse rates increased from 39% (95% confidence interval [CI], 33%-44%) in 1989-1994 to 58% (95% CI, 51%-64%; P < .001) in the 2001-2005 cohort. Projected 5-year progression-free survival and OS are 14% (95% CI, 9%-20%) and 29% (95% CI, 23%-35%), respectively, in the latest cohort. Increasing age, longer interval from diagnosis to transplantation, and unrelated donor grafts adversely affected OS in multivariate analysis. Survival at 5 years for subjects with none, 1, 2, or 3 of these risk factors were 41% (range, 36%-47%), 32% (range, 27%-37%), 25% (range, 19%-31%), and 3% (range, 0%-11%), respectively (P < .0001).
authors.affiliation: Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Shaji
authors.initials: S
authors.lastname: Kumar
authors.forename: Mei-Jie
authors.initials: MJ
authors.lastname: Zhang
authors.forename: Peigang
authors.initials: P
authors.lastname: Li
authors.forename: Angela
authors.initials: A
authors.lastname: Dispenzieri
authors.forename: Gustavo A
authors.initials: GA
authors.lastname: Milone
authors.forename: Sagar
authors.initials: S
authors.lastname: Lonial
authors.forename: Amrita
authors.initials: A
authors.lastname: Krishnan
authors.forename: Angelo
authors.initials: A
authors.lastname: Maiolino
authors.forename: Baldeep
authors.initials: B
authors.lastname: Wirk
authors.forename: Brendan
authors.initials: B
authors.lastname: Weiss
authors.forename: César O
authors.initials: CO
authors.lastname: Freytes
authors.forename: Dan T
authors.initials: DT
authors.lastname: Vogl
authors.forename: David H
authors.initials: DH
authors.lastname: Vesole
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Meehan
authors.forename: Mehdi
authors.initials: M
authors.lastname: Hamadani
authors.forename: Michael
authors.initials: M
authors.lastname: Lill
authors.forename: Natalie S
authors.initials: NS
authors.lastname: Callander
authors.forename: Navneet S
authors.initials: NS
authors.lastname: Majhail
authors.forename: Peter H
authors.initials: PH
authors.lastname: Wiernik
authors.forename: Rajneesh
authors.initials: R
authors.lastname: Nath
authors.forename: Rammurti T
authors.initials: RT
authors.lastname: Kamble
authors.forename: Ravi
authors.initials: R
authors.lastname: Vij
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kyle
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.forename: Parameswaran N
authors.initials: PN
authors.lastname: Hari
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000601:surgery* / Q000628:therapy*; D033581:Stem Cell Transplantation / Q000009:adverse effects / Q000639:trends*; D016019:Survival Analysis; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000639:trends*; D016896:Treatment Outcome; D055815:Young Adult