Donor versus no-donor comparison of newly diagnosed myeloma patients included in the HOVON-50 multiple myeloma study

Abstract

To prospectively evaluate allogeneic stem cell transplantation (allo-SCT) for myeloma as part of first-line therapy, a donor versus no-donor analysis was performed of patients treated in the HOVON-50 study, a study that was originally designed to examine thalidomide combined with intensive therapy. Two hundred sixty patients having received an autologous-SCT fulfilled the criteria to be included, 138 patients without an HLA-identical sibling donor and 122 patients with a donor. After a median follow-up of 77 months, complete remission, progression-free survival (PFS), and overall survival were not significantly different between the 2 groups. PFS at 6 years was 28% for patients with a donor versus 22% for patients without a donor (P ‫؍‬ .19) and overall survival at 6 years from high-dose melphalan was 55%, irrespective of having a donor (P ‫؍‬ .68). Cumulative incidence of nonrelapse mortality at 6 years after autologous-SCT was 16% in the donor group versus 3% in the nodonor group (P < .001). However, PFS was significantly prolonged in the 99 patients who actually proceeded to allo-SCT compared with the 115 patients who continued maintenance or received a second highdose melphalan, but the difference did not translate into a prolonged survival benefit. These results do not support a general application of allo-SCT in all myeloma patients as part of first-line therapy. (Blood. 2012; 119(26):6219-6225)

Reduced intensity-conditioned allogeneic stem cell transplantation for multiple myeloma relapsing or progressing after autologous transplantation: a study by the European Group for Blood and Marrow Transplantation

“…17,18,21 They are, however, worse than those for patients undergoing upfront RIC allo-SCT, which is not unexpected, given the prolonged disease history and more extensive prior therapies. [4][5][6][7][8][9][10][11][12] Although the relatively high NRM that we observed has to be taken into consideration, the data presented in this manuscript show that CMV-seronegative patients who have a CMV-seronegative donor have a substantially reduced NRM that translates into an encouraging 5-year survival of 440%. Considering that almost half (44.6%) of the patients in this study had undergone two or more prior autografts, our findings provide support to the notion that RIC allo-SCT can be an effective treatment option for some heavily pretreated patients.…”

“…3 Over the last decade, a number of studies investigated up-front reduced intensity-conditioned (RIC) allo-SCT and reported substantially lower NRM rates compared with MA allo-SCT. [4][5][6][7][8][9][10][11][12][13] Whereas some of these studies reported better longterm outcomes with RIC allo-SCT compared with tandem autologous hematopoietic SCT (auto-SCT), others failed to demonstrate a benefit of up-front RIC allo-SCT. Therefore, there is widespread reluctance to offer patients' up-front allo-SCT, which is at least partly due to prolonged remissions that can be achieved following induction and/or maintenance therapy with novel agents.…”

Comparison of upfront tandem autologous–allogeneic transplantation versus reduced intensity allogeneic transplantation for multiple myeloma

“…1,2 These data led to several prospective randomized studies comparing tandem autoallo transplant to single or tandem auto-PSCT. [3][4][5][6][7][8][9][10] Overall, studies show a lower relapse rate in allograft-containing arms but with no OS benefit. Two of the studies with long-term follow-up show improved PFS and OS in favor of tandem auto-allograft.…”

Allogeneic stem cell transplantation for multiple myeloma: is there a future?

“…29,30 In 2007, Bruno et al 31 described the outcomes of 245 patients, o 65 years old, biologically assigned (on sibling donor availability) to allo-SCT vs a second tandem ASCT after initial induction. 31 Eighty patients with an HLA-identical sibling were assigned to 200 cGy (Gray) TBI-based allotransplant, whereas 82 patients without an HLA-identical sibling were assigned to receive a second ASCT.…”