title: Allogeneic stem cell transplantation in multiple myeloma relapsed after autograft: a multicenter retrospective study based on donor availability.
abstract: Allogeneic stem cell transplantation (allo-SCT) using reduced-intensity conditioning (RIC) is a feasible procedure in selected patients with relapsed multiple myeloma (MM), but its efficacy remains a matter of debate. The mortality and morbidity related to the procedure and the rather high relapse risk make the use of allo-SCT controversial. In addition, the availability of novel antimyeloma treatments, such as bortezomib and immunomodulatory agents, have made allo-SCT less appealing to clinicians. We investigated the role of RIC allo-SCT in patients with MM who relapsed after autologous stem cell transplantation and were then treated with a salvage therapy based on novel agents. This study was structured similarly to an intention-to-treat analysis and included only those patients who underwent HLA typing immediately after the relapse. Patients with a donor (donor group) and those without a suitable donor (no-donor group) were compared. A total of 169 consecutive patients were evaluated retrospectively in a multicenter study. Of these, 75 patients found a donor and 68 (91%) underwent RIC allo-SCT, including 24 from an HLA-identical sibling (35%) and 44 from an unrelated donor (65%). Seven patients with a donor did not undergo allo-SCT for progressive disease or concomitant severe comorbidities. The 2-year cumulative incidence of nonrelapse mortality was 22% in the donor group and 1% in the no-donor group (P < .0001). The 2-year progression-free survival (PFS) was 42% in the donor group and 18% in the no-donor group (P < .0001). The 2-year overall survival (OS) was 54% in the donor group and 53% in the no-donor group (P = .329). In multivariate analysis, lack of a donor was a significant unfavorable factor for PFS, but not for OS. Lack of chemosensitivity after salvage treatment and high-risk karyotype at diagnosis significantly shortened OS. In patients who underwent allo-SCT, the development of chronic graft-versus-host disease had a significant protective effect on OS. This study provides evidence for a significant PFS benefit of salvage treatment with novel drugs followed by RIC allo-SCT in patients with relapsed MM who have a suitable donor.
authors.affiliation: Hematology, Department of Experimental Clinical Medicine, Udine, Italy. patriarca.francesca@aoud.sanita.fvg.it
authors.forename: Francesca
authors.initials: F
authors.lastname: Patriarca
authors.forename: Hermann
authors.initials: H
authors.lastname: Einsele
authors.forename: Francesco
authors.initials: F
authors.lastname: Spina
authors.forename: Benedetto
authors.initials: B
authors.lastname: Bruno
authors.forename: Miriam
authors.initials: M
authors.lastname: Isola
authors.forename: Chiara
authors.initials: C
authors.lastname: Nozzoli
authors.forename: Andrea
authors.initials: A
authors.lastname: Nozza
authors.forename: Alessandra
authors.initials: A
authors.lastname: Sperotto
authors.forename: Fortunato
authors.initials: F
authors.lastname: Morabito
authors.forename: Gernot
authors.initials: G
authors.lastname: Stuhler
authors.forename: Moreno
authors.initials: M
authors.lastname: Festuccia
authors.forename: Alberto
authors.initials: A
authors.lastname: Bosi
authors.forename: Renato
authors.initials: R
authors.lastname: Fanin
authors.forename: Paolo
authors.initials: P
authors.lastname: Corradini
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001897:Boronic Acids / Q000008:administration & dosage / Q000627:therapeutic use; D000069286:Bortezomib; D018572:Disease-Free Survival; D006086:Graft vs Host Disease / Q000276:immunology / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D008875:Middle Aged; D009101:Multiple Myeloma / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D019653:Myeloablative Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D011719:Pyrazines / Q000008:administration & dosage / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D016879:Salvage Therapy; D013792:Thalidomide / Q000008:administration & dosage / Q000627:therapeutic use; D014019:Tissue Donors; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous
chemical_list: D000970:Antineoplastic Agents; D001897:Boronic Acids; D019653:Myeloablative Agonists; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib