Predictors of prolonged survival after allogeneic hematopoietic stem cell transplantation for multiple myeloma.
A total of 149 patients with multiple myeloma (MM) who received allogeneic hematopoietic stem cell transplantation (allo-HCT) with myeloablative (MAC; n = 38) or reduced-intensity conditioning (RIC; n = 110) regimens at MD Anderson Cancer Center were evaluated. Of the total, 120 (81%) patients had relapsed or had refractory disease. Median age of MM patients was 50 (28-70) years with a followup time of 28.5 (3-164) months. The 100-day and 5-year treatment related mortality (TRM) rates were 17% and 47%, respectively. TRM was significantly lower with RIC regimens (13%) vs. 29% for MAC at 100 days (P = 0.012). The cumulative incidence of Grade II-IV acute graft-versus-host disease (GVHD) was 35% and chronic GVHD was 46%. PFS and OS at 5 years were 15% and 21%, respectively. In multivariate analysis, allo-HCT for primary remission consolidation was associated with longer PFS (HR 0.35; 95% CI, 0.18-0.67) and OS (HR 0.29; 95% CI 0.15-0.55), while absence of high-risk cytogenetics was associated with longer PFS only (HR 0.59; 95% CI 0.37-0.95). We observe that TRM has decreased with the use of RIC regimens, and long-term disease control can be expected in a subset of MM patients undergoing allo-HCT. Further studies should be conducted in carefully designed clinical trials in this patient population.
Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030-4009, USA. qbashir@mdanderson.org
Qaiser
Q
Bashir
Hassan
H
Khan
Robert Z
RZ
Orlowski
Ali Imran
AI
Amjad
Nina
N
Shah
Simrit
S
Parmar
Wei
W
Wei
Gabriela
G
Rondon
Donna M
DM
Weber
Michael
M
Wang
Sheeba K
SK
Thomas
Jatin J
JJ
Shah
Sofia R
SR
Qureshi
Yvonne T
YT
Dinh
Uday
U
Popat
Paolo
P
Anderlini
Chitra
C
Hosing
Sergio
S
Giralt
Richard E
RE
Champlin
Muzaffar H
MH
Qazilbash
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D060830:Consolidation Chemotherapy; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000453:epidemiology; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000235:genetics / Q000401:mortality / Q000601:surgery*; D019653:Myeloablative Agonists / Q000627:therapeutic use; D055031:Primary Graft Dysfunction / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous / Q000401:mortality
D007166:Immunosuppressive Agents; D019653:Myeloablative Agonists