title: Evolving strategies with immunomodulating drugs and tandem autologous/allogeneic hematopoietic stem cell transplantation in first line high risk multiple myeloma patients.
abstract: We prospectively evaluated in high-risk myeloma patients the efficacy and toxicity of tandem autologous hematopoietic stem cell transplantation (auto-HSCT) followed by reduced-intensity conditioning (RIC) and allogeneic (allo)-HSCT with bortezomib and donor lymphocyte infusions introduction after allo-HSCT (group 1). Results were compared with results from tandem auto-RIC-allo-HSCT without bortezomib (group 2). Groups 1 and 2 were compared to matched patients not receiving allo-HSCT from the Intergroupe Francophone du Myélome prospective studies. Allo-HSCT groups included 25 patients (12 in group 1, 13 in group 2). All patients engrafted. There were 8 acute GVHD (7 grade II [3 in group 1], 1 grade III in group 1)] and 11 chronic GVHD (3 limited [in group 1], 8 extensive [1 in group 1]). Matched population included 36 controls for group 1 and 39 for group 2. After a median follow-up of 55 months (range, 3-142 months), median overall survival was not reached in group 1 versus 65 months (51-not reached [NR]) in its matched group (p = 0.027); it was 96 months (49-NR) in group 2 versus 91 months (32-NR) in its matched group (p = 0.77). Median progression-free survival was 49 months (29-NR) in group 1 and was 25 months (range, 21-35 months) in its matched group (p = 0.0045); it was 31 months (22-NR) in group 2 and 28 months (range, 21-40 months) in its matched group (p = 0.0776). Tandem auto-RIC-allo-HSCT including new molecules and immunomodulation after transplantation could be used as a first-line treatment for high-risk myeloma patients.
authors.affiliation: Hematology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France. Electronic address: mauricette.michallet@chu-lyon.fr.
authors.forename: Mauricette
authors.initials: M
authors.lastname: Michallet
authors.forename: Mohamad
authors.initials: M
authors.lastname: Sobh
authors.forename: Jean
authors.initials: J
authors.lastname: El-Cheikh
authors.forename: Stéphane
authors.initials: S
authors.lastname: Morisset
authors.forename: Anne
authors.initials: A
authors.lastname: Sirvent
authors.forename: Oumedaly
authors.initials: O
authors.lastname: Reman
authors.forename: Jérôme
authors.initials: J
authors.lastname: Cornillon
authors.forename: Reza
authors.initials: R
authors.lastname: Tabrizi
authors.forename: Noel
authors.initials: N
authors.lastname: Milpied
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Harousseau
authors.forename: Hélène
authors.initials: H
authors.lastname: Labussière
authors.forename: Franck-Emmanuel
authors.initials: FE
authors.lastname: Nicolini
authors.forename: Michel
authors.initials: M
authors.lastname: Attal
authors.forename: Philippe
authors.initials: P
authors.lastname: Moreau
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise
authors.forename: Hérvé
authors.initials: H
authors.lastname: Avet-Loiseau
mesh_terms: D000328:Adult; D000368:Aged; D001897:Boronic Acids / Q000627:therapeutic use; D000069286:Bortezomib; D003131:Combined Modality Therapy; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D017710:Lymphocyte Transfusion; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D011719:Pyrazines / Q000627:therapeutic use; D016019:Survival Analysis; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D001897:Boronic Acids; D007155:Immunologic Factors; D011719:Pyrazines; D000069286:Bortezomib