title: Outcome of allogeneic transplantation in newly diagnosed and relapsed/refractory multiple myeloma: long-term follow-up in a single institution.
abstract: Allogeneic stem cell transplantation (allo-SCT) has the potential to induce long-term remission in multiple myeloma (MM), but the role of allo-SCT in MM is controversial due to the high rate of treatment-related mortality (TRM). However, although proteasome inhibitors and immunomodulatory drugs have improved the outcome of patients with MM, high-risk patients still have a very poor prognosis. This indicates the need for new treatment strategies and identification of patients who might benefit from allo-SCT. We therefore analyzed the outcome of one hundred and forty-seven patients with MM who received an allo-SCT at our institution (58 in first line, 89 in relapsed/refractory setting) after a median follow-up of 88.8 months. For the first-line setting, median progression-free survival (PFS) and overall survival (OS) were remarkably good, with a CR rate of 48.3%, median PFS of 30.2 months, and 10-yr OS of 51%. We found no difference in outcome for patients with high-risk metaphase cytogenetics or FISH del(13q14), but efficacy in current standard high-risk patients could not be determined. The outcome in the relapsed/refractory setting was poor, especially in the subgroup of patients relapsing within 18 months after auto-SCT. Therefore, if applied at all in these patients, improvement of allo-SCT is needed, focusing on reduction of TRM and more effective immunotherapy.
authors.affiliation: Department of Hematology, University Medical Center Utrecht, Utrecht, the Netherlands.|Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Laurens E
authors.initials: LE
authors.lastname: Franssen
authors.affiliation: Department of Hematology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Reinier A P
authors.initials: RA
authors.lastname: Raymakers
authors.affiliation: Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Arjan
authors.initials: A
authors.lastname: Buijs
authors.affiliation: Department of Hematology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Marian F
authors.initials: MF
authors.lastname: Schmitz
authors.affiliation: Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: van Dorp
authors.affiliation: Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Tuna
authors.initials: T
authors.lastname: Mutis
authors.affiliation: Department of Hematology, University Medical Center Utrecht, Utrecht, the Netherlands.|Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Henk M
authors.initials: HM
authors.lastname: Lokhorst
authors.affiliation: Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands. n.vandedonk@vumc.nl.
authors.forename: Niels W C J
authors.initials: NW
authors.lastname: van de Donk
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence; D019233:Retreatment; D014184:Transplantation, Homologous; D016896:Treatment Outcome
keywords: allogeneic stem cell transplantation; immunotherapy; multiple myeloma