title: The graft-versus-myeloma effect: chronic graft-versus-host disease but not acute graft-versus-host disease prolongs survival in patients with multiple myeloma receiving allogeneic transplantation.
abstract: We conducted a study of patients with multiple myeloma (MM) undergoing allogeneic transplantation to evaluate outcome parameters. Fifty-seven consecutive patients with MM received an allogeneic transplantation between 2004 and 2011 at our institution. Patients who had received at least 1 prior autologous transplantation were included. Twenty-six patients underwent allogeneic transplantation for consolidation after a response to their first autograft, and 30 patients received an allogeneic transplantation as salvage therapy. Donor source was evenly distributed between related and unrelated. The median follow-up was 52 months. Thirty-two (57.1%) patients achieved a complete response (CR). At 5 years, 49.2% of all patients were in CR. Sixteen patients received either donor lymphocyte infusions or immune suppression withdrawal for disease progression, with a 62.5% response rate. The 5-year overall survival (OS) for all patients was 59%. The 5-year OS for the 30 patients in the consolidation group was 82% compared with 38% for those in the salvage group. In multivariate analysis, 3 factors remained significantly associated with OS. These include being in the salvage group (hazard ratio [HR], 4.05; P = .0196), acute graft-versus-host disease (aGVHD) (HR, 2.99; P = .034), and chronic graft-versus-host disease (cGVHD), which was highly protective, with a 5-year OS of 78.8% for patients with cGVHD versus 42.6% for patients without cGVHD (HR .17, P = .008). Our data show that allogeneic transplantation for MM can lead to sustained remissions. aGVHD is significantly deleterious to OS and progression-free survival, whereas cGVHD is strongly favorable, supporting an important role for the graft-versus-myeloma effect.
authors.affiliation: John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey. Electronic address: mdonato@hackensackumc.org.
authors.forename: Michele L
authors.initials: ML
authors.lastname: Donato
authors.affiliation: John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey.
authors.forename: David S
authors.initials: DS
authors.lastname: Siegel
authors.affiliation: John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey.
authors.forename: David H
authors.initials: DH
authors.lastname: Vesole
authors.affiliation: John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey.
authors.forename: Phyllis
authors.initials: P
authors.lastname: McKiernan
authors.affiliation: John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey.
authors.forename: Themba
authors.initials: T
authors.lastname: Nyirenda
authors.affiliation: John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Pecora
authors.affiliation: John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey.
authors.forename: Melissa
authors.initials: M
authors.lastname: Baker
authors.affiliation: John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey.
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Goldberg
authors.affiliation: John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey.
authors.forename: Anthony
authors.initials: A
authors.lastname: Mato
authors.affiliation: John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey.
authors.forename: Andre
authors.initials: A
authors.lastname: Goy
authors.affiliation: John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Rowley
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods* / Q000401:mortality; D014184:Transplantation, Homologous / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome
keywords: Allogeneic; Graft-versus-host-disease; Multiple myeloma; Transplantation