Allogeneic hematopoietic SCT in multiple myeloma: long-term results from a single institution

Abstract

The role of allogeneic hematopoietic SCT (allo-HCT) in multiple myeloma (MM) remains controversial. A total of 58 patients received an allo-HCT (25 of them with myeloablative conditioning-allo-MAC-and 33 with reduced-intensity conditioning-allo-RIC) at our institution over a 28-year period. The CR rate for allo-MAC was 36%. The incidence of grade III-IV acute GVHD (aGVHD) and chronic GVHD (cGVHD) was 28% and 39%, respectively The TRM at any time was 60% and the main causes of death were aGVHD or infectious complications not directly related to GVHD. The estimated PFS and OS at 15 years were 8% and 15%, respectively. The CR rate with allo-RIC was 45%. The incidence of grade III-IV aGVHD and cGVHD were 24% and 41%, respectively. The TRM at any time was 33% and was mainly related to aGVHD. The estimated PFS and OS at 5 years were 22% and 38%, respectively. Despite its high TRM, a proportion of patients with high-risk myeloma (early relapse and newly diagnosed ultrahigh risk) may obtain long-term disease control with allo-HCT. New approaches aimed at decreasing the incidence of aGVHD, and consequently to decrease the TRM, are needed.

Allogeneic stem-cell transplantation for multiple myeloma: a systematic review and meta-analysis from 2007 to 2017

“…In the trials involved in our meta-analysis, 55 [ 10 – 15 , 17 , 19 – 25 , 27 – 36 , 38 – 52 , 57 – 65 , 67 – 73 ] trials reported grades 2–4 acute GVHD (aGVHD) with the incidence varying from 2.3 to 69.6%, 38 trials [ 10 , 11 , 13 , 14 , 21 , 23 , 25 , 27 – 30 , 32 – 34 , 36 , 38 , 40 – 42 , 44 , 45 , 47 – 50 , 52 , 58 , 59 , 61 , 63 – 65 , 67 – 70 , 72 , 74 ] reported extensive chronic GVHD (cGVHD) with the incidence ranging from 5.3 to 79.3%, and 30 trials [ 11 , 13 , 22 , 23 , 25 , 27 – 34 , 36 – 38 , 40 , 42 , 44 , 45 , 48 – 50 , 58 , 59 , 63 , 64 , 68 , 69 , 72 ] reported limited cGVHD with the incidence varying from 5.1 to 46.3%. There were significant heterogeneity in the pooled estimates of the incidence of aGVHD (p = 0, I 2 = ...…”

“…Subgroup analysis demonstrated a markedly reduced incidence of TRM in patients underwent planned auto-SCT before allo-SCT compared with those direct to allo-SCT [ 26 , 40 ]. In contrast, there was increasing the risk of TRM in patients receiving auto-allo-SCT [ 16 , 42 , 49 ] or MA regimens [ 10 , 13 , 29 , 45 ] compared with those receiving tandem-auto-SCT or RIC/NMA-HCT regimens. Since major transplant innovation and new technologies emerged in 2000, we compared the TRM of transplantation period 1990s and 2000s.…”

“…37 [ 10 – 13 , 15 , 19 , 20 , 22 , 24 , 26 – 28 , 31 – 33 , 36 , 38 , 40 , 42 – 45 , 47 – 50 , 57 – 60 , 64 – 67 , 69 , 72 , 73 ] out of 61 trials reported the results of RR with the incidence ranging from 14.3 to 91.3%. The pooled estimate (95% CI) for RR was 50 (95% CI 45–55%).…”

“…3 trials showed patients after MA-SCT had lower RR than RIC/NMA-SCT [ 13 , 25 , 45 ], and 2 trials indicated a trend that RR was significantly lower in auto-allo-SCT patients compared with tandem-auto-SCT [ 42 , 49 ]. Most trials reported death rate and the death cause [ 10 – 12 , 14 , 19 , 20 , 22 , 24 , 26 , 28 – 33 , 35 , 36 , 38 , 40 , 45 , 47 , 48 , 51 , 58 – 61 , 63 – 65 , 67 , 69 – 71 , 74 ]. The death rate ranged from 7.9 to 92.4%, and the pooled death rate was 51 (95% CI 45–57%).…”

Expert review on soft‐tissue plasmacytomas in multiple myeloma: definition, disease assessment and treatment considerations

“…Considering that daratumumab improves the efficacy of VMP and also RVD, the addition of a CD38‐targeting MoAb would be most reasonable. For transplant‐eligible patients, a combined intensive anti‐myeloma/anti‐lymphoma regimen such as VTD or VRD/cisplatin, doxorubicin, cyclophosphamide and etoposide (PACE) 103 followed by a tandem ASCT or ASCT followed by Allo‐RIC seems theoretically an alternative option 104 (Table II). Although these patients usually respond to induction therapy, early relapse is very common 105 .…”