title: Donor versus no-donor comparison of newly diagnosed myeloma patients included in the HOVON-50 multiple myeloma study.
abstract: To prospectively evaluate allogeneic stem cell transplantation (allo-SCT) for myeloma as part of first-line therapy, a donor versus no-donor analysis was performed of patients treated in the HOVON-50 study, a study that was originally designed to examine thalidomide combined with intensive therapy. Two hundred sixty patients having received an autologous-SCT fulfilled the criteria to be included, 138 patients without an HLA-identical sibling donor and 122 patients with a donor. After a median follow-up of 77 months, complete remission, progression-free survival (PFS), and overall survival were not significantly different between the 2 groups. PFS at 6 years was 28% for patients with a donor versus 22% for patients without a donor (P = .19) and overall survival at 6 years from high-dose melphalan was 55%, irrespective of having a donor (P = .68). Cumulative incidence of nonrelapse mortality at 6 years after autologous-SCT was 16% in the donor group versus 3% in the no-donor group (P < .001). However, PFS was significantly prolonged in the 99 patients who actually proceeded to allo-SCT compared with the 115 patients who continued maintenance or received a second high-dose melphalan, but the difference did not translate into a prolonged survival benefit. These results do not support a general application of allo-SCT in all myeloma patients as part of first-line therapy.
authors.affiliation: Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands. h.lokhorst@umcutrecht.nl
authors.forename: Henk M
authors.initials: HM
authors.lastname: Lokhorst
authors.forename: Bronno
authors.initials: B
authors.lastname: van der Holt
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Cornelissen
authors.forename: Marie-José
authors.initials: MJ
authors.lastname: Kersten
authors.forename: Marinus
authors.initials: M
authors.lastname: van Oers
authors.forename: Reinier
authors.initials: R
authors.lastname: Raymakers
authors.forename: Monique C
authors.initials: MC
authors.lastname: Minnema
authors.forename: Sonja
authors.initials: S
authors.lastname: Zweegman
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Janssen
authors.forename: Mark
authors.initials: M
authors.lastname: Zijlmans
authors.forename: Gerard
authors.initials: G
authors.lastname: Bos
authors.forename: Nicolaas
authors.initials: N
authors.lastname: Schaap
authors.forename: Shulamiet
authors.initials: S
authors.lastname: Wittebol
authors.forename: Okke
authors.initials: O
authors.lastname: de Weerdt
authors.forename: Rianne
authors.initials: R
authors.lastname: Ammerlaan
authors.forename: Pieter
authors.initials: P
authors.lastname: Sonneveld
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D020360:Neoadjuvant Therapy; D009426:Netherlands; D035781:Siblings; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous; D016896:Treatment Outcome