Efficacy and Outcome of Allogeneic Transplantation in IgD and Nonsecretory Myeloma. A Report on Behalf of the Myeloma Subcommittee of the Chronic Malignancies Working Party of the European Group for Blood and Marrow Transplantation

Abstract

We have recently reported on the outcome of autologous transplantation in the rare myelomas (IgD, IgE, IgM, and nonsecretory [NS]) but there is no real information on the outcome of these conditions after allogeneic transplantation. We used the European Group for Blood and Marrow Transplantation myeloma database to compare the outcomes after allogeneic transplantation of 1354 common myelomas (IgG, IgA, and light chain myeloma) with the outcome in 26 IgD myelomas and 52 NS myelomas. There was little difference between common and the IgD and NS myeloma patients with respect to prognostic factors although the IgD group had a higher beta 2 microglobulin at diagnosis, shorter time to transplantation, and more T cell depletion. IgD and NS patients had a significantly greater achievement of complete remission at conditioning but this did not translate into equivalent progression-free survival and overall survival for the IgD patients although the NS outcome was very similar to that of common myeloma. The PFS and OS of IgD, common, and NS myelomas appear similar after allogeneic transplantation, despite a tendency for higher early relapse rate in IgD myeloma. Allogeneic transplantation may, therefore, be an option to investigate in prospective observational studies.

Reducing Treatment-Related Mortality Did Not Improve Outcomes of Allogeneic Myeloablative Hematopoietic Cell Transplantation for High-Risk Multiple Myeloma: A University of Michigan Prospective Series

“…43 Allogeneic hematopoietic cell transplantation, which utilizes an alloimmune reaction against MM (GVM effect), has emerged as an alternative treatment option, with possible prolonged MM control and curative potential, in these patients. [12][13][14][15][16][17][18][19][20][21] The existence of GVM effect was demonstrated directly in patients who received DLI for MM relapse after Allo-HCT. [16][17][18] DLI was shown to induce complete and partial response in 40-55% of these patients, with accompanying acute and chronic GVHD rates of 55-57% and 26-47%, respectively.…”

“…[7][8][9][10][11] Allogeneic hematopoietic cell transplantation (Allo-HCT) has been explored in advanced MM as a curative option through a graft-versus-myeloma (GVM) effect. [12][13][14][15][16][17][18][19][20][21] The existence of a GVM effect was demonstrated following the observation of complete responses after donor lymphocyte infusion (DLI) and withdrawal of immunosuppression in patients with MM relapsing after Allo-HCT. [16][17][18] Unfortunately, conventional myeloablative conditioning is associated with an unacceptably high early treatment-related mortality (TRM) of up to 50%.…”

Secretory status of monoclonal immunoglobulin is related to the outcome of patients with myeloma: a retrospective study

“…21,22 Although the precise causes of renal dysfunction in our patients with oligosecretory myeloma in our study were not defined, there was a high frequency of IgD MM, consistent with prior reports of shorter OS and higher frequency of renal dysfunction. 22,23 We also analyzed the cytogenetic characteristics in patients with unmeasurable and measurable MM, and found that patients with unmeasurable disease were more commonly t (11;14). Other factors such as ploidy, del(17p), del(13p), 1q21 gains, t(4;14), and t (14;16) were not significantly different between patients with measurable and unmeasurable disease.…”

A novel protein encoded by circHNRNPU promotes multiple myeloma progression by regulating the bone marrow microenvironment and alternative splicing

“…As a most severe type among all the subtypes of MM, immunoglobulin D multiple myeloma (IgD MM) is very rare comprising only 1 to 2% of all MM cases featured by diagnosis in relatively young patients, and often accompanied by multiple adverse prognosis, such as extraosseous lesions, renal failure, extramedullary involvement, amyloidosis [4,5]. The most distinguish characteristic of lgD MM is poor outcome of refractory status, only 13 ~ 21-month overall survival (OS) compared with 3 ~ 6-year overall median survival in common MM [6][7][8]. Therefore, systemic investigation on IgD MM is purposeful to reveal the recurrent and refractory features in both IgD and other types of MM, and beneficial to develop potent therapeutic strategy on MM.…”