title: Trends and outcomes in allogeneic hematopoietic stem cell transplant for multiple myeloma at Mayo Clinic.
abstract: BACKGROUND
  Allogeneic transplant in myeloma remains controversial.
  
  
  METHODS
  We performed a retrospective review of 76 patients in the Mayo Clinic database from 1993 to 2013 who underwent allogeneic hematopoietic stem cell transplant (HSCT) for myeloma.
  
  
  RESULTS
  After excluding ineligible patients, among the remaining 66 patients, median age at transplant was 42 years and 87% had residual disease at the time of transplant. Myeloablative (71%) versus reduced intensity conditioning (29%), matched sibling donors (70%) versus unrelated donors showed no outcome difference. Median overall survival from the time of diagnosis and transplant were 75 and 24 months, respectively. Median time to disease progression (TTP) was 15 months and treatment-related mortality was 20% at day 100. Acute and chronic graft versus host disease (cGVHD) developed in 61% and 48% patients, respectively. In univariate analysis of overall survival (OS), factors predicting adverse outcome were pretransplant 24-hour total urinary protein (P = .035), peripheral blood versus bone marrow (OS 18 vs. 41 months; P = .02), number of previous therapies (P = .014), time from autologous to allogeneic HSCT (P = .019), and cGVHD (P = .01). TTP was adversely affected by number of previous regimens (P = .036) and PB as graft source (P = .016). In multivariate analysis for progression-free survival, number of previous regimens (P = .04), and for OS, time between autologous and allogeneic HSCT was significant (P = .009).
  
  
  CONCLUSIONS
  In 162 matched control subjects who were human leukocytoe antigen-typed, there were no survivors at 12 years compared with 20% in the group who received a transplant. In a second control group with 197 second autologous transplants, 10-year OS was 8%.
authors.affiliation: Penn State Hershey Cancer Institute, Hershey, PA. Electronic address: mmir@hmc.psu.edu.
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Mir
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, MN.
authors.forename: Prashant
authors.initials: P
authors.lastname: Kapoor
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, MN.
authors.forename: Shaji
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Louisiana State University/E.A. Conway Medical Center, Monroe, LA.
authors.forename: Shivlal
authors.initials: S
authors.lastname: Pandey
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, MN.
authors.forename: Angela
authors.initials: A
authors.lastname: Dispenzieri
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, MN.
authors.forename: Martha Q
authors.initials: MQ
authors.lastname: Lacy
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, MN.
authors.forename: David
authors.initials: D
authors.lastname: Dingli
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, MN.
authors.forename: William
authors.initials: W
authors.lastname: Hogan
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, MN.
authors.forename: Francis
authors.initials: F
authors.lastname: Buadi
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, MN.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Hayman
authors.affiliation: Division of Transfusion Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Manish
authors.initials: M
authors.lastname: Gandhi
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, MN.
authors.forename: Morie A
authors.initials: MA
authors.lastname: Gertz
mesh_terms: D000328:Adult; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000401:mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy*; D019233:Retreatment; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D019172:Transplantation Conditioning / Q000379:methods; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous / Q000639:trends; D016896:Treatment Outcome
keywords: Allogeneic transplant; Multiple myeloma outcomes