title: Allogeneic Hematopoietic Cell Transplantation in Multiple Myeloma: Impact of Disease Risk and Post Allograft Minimal Residual Disease on Survival.
abstract: Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative option for multiple myeloma (MM). We analyzed our experience of allo-HCT in MM and examined outcomes in 77 consecutive patients with MM receiving allo-HCT from matched sibling (n = 69) or unrelated donors (n = 8). The primary objectives were to assess overall survival (OS), progression-free survival (PFS), and non-relapse mortality in these patients.
  
  
  
  Sixty-six patients received non-myeloablative/reduced-intensity conditioning regimens, while 11 received myeloablative regimens. The median follow-up of survivors was 50 months (range, 2.3-129.3 months).
  
  
  
  Twenty-seven (35.1%) patients had high-risk cytogenetics at diagnosis (t (4:14), 17p deletion, chromosome 1 abnormality, or t (14:16)). All of patients except 1 had prior auto transplant. On multivariate analysis, older age (hazard ratio [HR], 1.055; 95% confidence interval [CI], 1.001 = 1.11; P = .04), less than complete remission (CR) at allo-HCT (HR, 4.3; 95% CI, 1.3-14.1; P = .006), and cytomegalovirus reactivation (HR, 3.2; 95% CI, 1.38-7.6; P = .002) were associated with higher mortality risk. Less than CR at allo-HCT was also associated with higher risk for non-relapse mortality (HR, 5.8; 95% CI, 1.3-26.3; P = .02). There was no difference in OS or PFS between high-risk and standard-risk cytogenetics. No difference in OS and PFS was seen in those who had morphological complete response regardless of the minimal residual disease status.
  
  
  
  Allotransplant benefited younger patients and those in CR at the time of transplant. The adverse effect of high-risk cytogenetics may be overcome by the allo-HCT.
authors.affiliation: Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Binod
authors.initials: B
authors.lastname: Dhakal
authors.affiliation: Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Anita
authors.initials: A
authors.lastname: D'Souza
authors.affiliation: Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Michael
authors.initials: M
authors.lastname: Martens
authors.affiliation: Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kapke
authors.affiliation: Department of Pathology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Harrington
authors.affiliation: Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Pasquini
authors.affiliation: Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Wael
authors.initials: W
authors.lastname: Saber
authors.affiliation: Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: William R
authors.initials: WR
authors.lastname: Drobyski
authors.affiliation: Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Mei Jie
authors.initials: MJ
authors.lastname: Zhang
authors.affiliation: Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Hamadani
authors.affiliation: Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI. Electronic address: phari@mcw.edu.
authors.forename: Parameswaran N
authors.initials: PN
authors.lastname: Hari
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers; D002869:Chromosome Aberrations; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000175:diagnosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Allogeneic stem cell transplantation; Minimal residual disease; Multiple myeloma; Risk status