CD34-Selected Allogeneic Hematopoietic Stem Cell Transplantation for Patients with Relapsed, High-Risk Multiple Myeloma.
We report results of a retrospective analysis of 44 patients with relapsed and high-risk multiple myeloma (MM) undergoing allogeneic CD34-selected hematopoietic stem cell transplantation (HSCT) from HLA-compatible donors. Patients had multiply relapsed disease including relapse at <15 months after autologous transplantation and most patients (28 of 44; 65%) also had high-risk cytogenetics. Before transplantation, patients received busulfan (.8 mg/kg × 10 doses), melphalan (70 mg/m(2) × 2 days), fludarabine (25 mg/m(2) × 5 days), and rabbit antithymocyte globulin (2.5 mg/kg × 2 days). Patients with 10/10 HLA- matched donors were treated prophylactically with low doses of donor lymphocyte infusions (.5 to 1 × 10(6) CD3(+)/kg) starting 4 to 6 months after CD34-selected HSCT. Acute (grade II to IV) graft-versus-host disease (GVHD) and transplantation-related mortality at 12 months were 2% and 18%, respectively. Chronic GVHD was not observed in any patient. Overall and progression-free survival at 2 years were 54% and 31%, respectively. By multivariate analyses, the outcomes of CD34-selected HSCT were influenced by presence of extramedullary disease, disease status before CD34-selected HSCT, and age. This study demonstrates notable safety and efficacy of CD34-selected HSCT in patients with multiply relapsed MM, including those with high-risk cytogenetics.
Hematology/Oncology/BMT Fellowship Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Memorial Sloan Kettering Cancer Center, New York, New York.
Eric
E
Smith
Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York; Memorial Sloan Kettering Cancer Center, New York, New York.
Sean M
SM
Devlin
Hematology/Oncology/BMT Fellowship Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Memorial Sloan Kettering Cancer Center, New York, New York.
Satyajit
S
Kosuri
Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Memorial Sloan Kettering Cancer Center, New York, New York.
Evelyn
E
Orlando
Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Multiple Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York; Memorial Sloan Kettering Cancer Center, New York, New York.
Heather
H
Landau
Multiple Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York; Memorial Sloan Kettering Cancer Center, New York, New York.
Alex M
AM
Lesokhin
Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Multiple Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York; Memorial Sloan Kettering Cancer Center, New York, New York.
David J
DJ
Chung
Multiple Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York; Memorial Sloan Kettering Cancer Center, New York, New York.
Hani
H
Hassoun
Multiple Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York; Memorial Sloan Kettering Cancer Center, New York, New York.
Nikoletta
N
Lendvai
Multiple Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York; Memorial Sloan Kettering Cancer Center, New York, New York.
Ola
O
Landgren
Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Multiple Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York; Memorial Sloan Kettering Cancer Center, New York, New York.
Sergio
S
Giralt
Multiple Myeloma Program, Mount Sinai Hospital, New York, New York.
Ajai
A
Chari
Multiple Myeloma Program, Mount Sinai Hospital, New York, New York.
Sundar
S
Jagannath
Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Multiple Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York; Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: koehneg@mskcc.org.
Guenther
G
Koehne
D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000378:metabolism*; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D016219:Immunotherapy, Adoptive / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous / Q000379:methods*
D018952:Antigens, CD34
Adoptive immunotherapy; D34-selected hematopoietic stem cell transplantation; Relapsed high-risk multiple myeloma