title: Favorable long-term outcome of patients with multiple myeloma using a frontline tandem approach with autologous and non-myeloablative allogeneic transplantation.
abstract: Despite survival improvement with novel agents and use of autologous hematopoietic stem cell transplantation (HSCT), cure of patients with multiple myeloma (MM) remains anecdotal. Initial observations suggested that chronic GvHD was accompanied by an anti-myeloma effect after myeloablative HSCT, but unfortunately this procedure was hampered by high non-relapse mortality (NRM). To maximize the anti-myeloma effect and minimize NRM, we developed a non-myeloablative (NMA) regimen associated with a high incidence of chronic GvHD and tested its efficacy on patient survival and disease eradication. From 2001 to 2010, 92 patients aged ⩽ 65 years with a compatible sibling donor received autologous HSCT followed by an outpatient NMA allogeneic HSCT using a conditioning of fludarabine and cyclophosphamide. Patient median age was 52 years and 97% presented Durie-Salmon stages II-III disease. After a median follow-up of 8.8 years, probability of 10-year progression free and overall survival were 41% and 62%, respectively. Although the cumulative incidence of extensive chronic GvHD was high (at 79%), the majority of long-term survivors were off immunosuppressive drugs by year 5 and NRM was low (at 10%). Together, our results suggest that potential MM cure can be achieved with NMA transplantation regimens that maximize graft-versus-myeloma effect and minimize NRM.
authors.affiliation: Division of Hematology and Medical Oncology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
authors.forename: I
authors.initials: I
authors.lastname: Ahmad
authors.affiliation: Division of Hematology and Medical Oncology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
authors.forename: R
authors.initials: R
authors.lastname: LeBlanc
authors.affiliation: Division of Hematology and Medical Oncology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Cohen
authors.affiliation: Division of Hematology and Medical Oncology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Lachance
authors.affiliation: Division of Hematology and Medical Oncology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Kiss
authors.affiliation: Division of Hematology and Medical Oncology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Sauvageau
authors.affiliation: Division of Hematology and Medical Oncology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
authors.forename: D C
authors.initials: DC
authors.lastname: Roy
authors.affiliation: Division of Hematology and Medical Oncology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Busque
authors.affiliation: Division of Hematology and Medical Oncology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
authors.forename: J-S
authors.initials: JS
authors.lastname: Delisle
authors.affiliation: Division of Hematology and Medical Oncology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Bambace
authors.affiliation: Division of Hematology and Medical Oncology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Bernard
authors.affiliation: Division of Hematology and Medical Oncology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
authors.forename: W
authors.initials: W
authors.lastname: Sabry
authors.affiliation: Division of Hematology and Medical Oncology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Roy
mesh_terms: D000328:Adult; D064591:Allografts; D064592:Autografts; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality* / Q000628:therapy*; D011446:Prospective Studies; D015996:Survival Rate; D019172:Transplantation Conditioning