title: Late relapses following reduced intensity allogeneic transplantation in patients with multiple myeloma: a long-term follow-up study.
abstract: We analysed the long-term outcomes of 60 multiple myeloma patients who underwent reduced intensity allogeneic stem cell transplantation between August 2000 and March 2008. Regimens included fludarabine and melphalan conditioning (flu-mel regimen) for allogeneic haematopoietic cell transplant (HCT) or a planned tandem regimen consisting of high-dose melphalan conditioning for autograft followed by low-dose total body irradiation conditioning for allogeneic HCT (auto-allo regimen). Donors included human-leucocyte-antigen-matched siblings (n = 55) or matched unrelated donors (n = 5). With a median follow-up of 9·8 years, 7-year overall survival (OS) and progression-free survival (PFS) were 60% and 31%, respectively. By multivariate Cox regression analysis, disease status of complete response (CR) or partial response (PR) at transplant and the presence of chronic graft-versus-host disease were significantly associated with improved OS. Only disease status was significantly associated with improved PFS. We noted a surprising number of very late relapses, with six patients (10%) relapsing between 6 and 12 years post-transplant. Among the six late relapse patients, all were transplanted within 14 months of diagnosis, five had normal karyotypes, and five were in CR/PR. Our data provide additional evidence that, while survival may be extended by reduced intensity allogeneic transplant, ultimately, it may not offer a cure.
authors.affiliation: Department of Hematology, City of Hope National Medical Center, Duarte, CA 91010, USA. fsahebi@coh.org
authors.forename: Firoozeh
authors.initials: F
authors.lastname: Sahebi
authors.forename: Yan
authors.initials: Y
authors.lastname: Shen
authors.forename: Sandra H
authors.initials: SH
authors.lastname: Thomas
authors.forename: Amalia
authors.initials: A
authors.lastname: Rincon
authors.forename: Joyce
authors.initials: J
authors.lastname: Murata-Collins
authors.forename: Joycelynne
authors.initials: J
authors.lastname: Palmer
authors.forename: Amrita Y
authors.initials: AY
authors.lastname: Krishnan
authors.forename: Chatchada
authors.initials: C
authors.lastname: Karanes
authors.forename: Myo
authors.initials: M
authors.lastname: Htut
authors.forename: George
authors.initials: G
authors.lastname: Somlo
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Forman
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000706:statistics & numerical data; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D019520:Living Donors; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000235:genetics / Q000401:mortality / Q000601:surgery*; D036102:Peripheral Blood Stem Cell Transplantation / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D013997:Time Factors; D019172:Transplantation Conditioning / Q000379:methods*; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives; D014916:Whole-Body Irradiation
chemical_list: D014740:Vidarabine; C024352:fludarabine; D008558:Melphalan