Long‐term outcome after allogeneic stem‐cell transplantation with reduced‐intensity conditioning in patients with multiple myeloma

Abstract

This study examines the long‐term outcomes of a cohort of patients with myeloma who were treated with reduced‐intensity conditioning (RIC) regimens after a minimum follow‐up of 5 years at our centre. A total of 53 patients with multiple myeloma (MM) who received allogeneic hematopoietic stem‐cell transplantation (Allo‐SCT) between January 2000 and January 2007 were identified. The median follow‐up of living patients was 84 months (51–141). The median age of the MM patients was 50 (28–70) years. Fifty‐one patients (96%) received a transplant from a sibling donor. The median time between diagnosis and Allo‐SCT was 34 months (6–161), and the median time between auto‐SCT and Allo‐SCT was 10 months (1–89). Fifty‐one patients (96%) received at least one auto‐SCT; 24 patients (45%) received a tandem auto‐Allo‐SCT. At last follow‐up, 21 patients (40%) are alive > 5 years post RIC Allo‐SCT. At last follow‐up, 14 (26%) are in first complete remission (CR), and four patients (8%) in second CR after donor lymphocyte infusion or re‐induction with one of the new anti‐myeloma drugs (bortezomib or lenalidomide) after Allo‐SCT. Eight patients (38%) among these long survivors received one of these new drugs as induction or relapse treatment before Allo‐SCT. Disease status and occurrence of cGvHD were significantly associated with progression‐free survival (PFS); hazard ratio (HR) = 0.62 (0.30–1.29, P = 0.20). Acute GvHD was correlated with higher transplant‐related mortality; HR = 4.19 (1.05–16.77, P = 0.04). No variables were associated with overall survival (OS). In conclusion, we observe that long‐term disease control can be expected in a subset of MM patients undergoing RIC Allo‐SCT. After 10 years, the OS and PFS were 32% and 24%, respectively. The PFS curve after Allo‐SCT stabilizes in time with a plateau after 6 years post Allo‐SCT. Am. J. Hematol. 88:370–374, 2013. © 2013 Wiley Periodicals, Inc.

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

“…The PFS and OS rates for the auto-allograft group in our study are very similar to those seen in previous prospective auto-allo studies with long-term follow-up, 5,6,[18][19][20] strengthening our findings. It is unlikely that any study will be performed to address the role of auto-PSCT prior to allogeneic transplant in the future.…”

“…Three-and 5-year PFS rates were 45% (41-50) and 34% (30-39) in the auto-allo group and 33% (25-41) and 22% (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) in the early RIC group, P o0.001 (Figure 1b). The cumulative incidence of relapse at 3 and 5 years was 41% (37-45%) and 50% (46-55) in the auto-allo and 39% (31-46) and 46% (38-54) in the early RIC groups, respectively, P = 0.42 (Figure 1c).…”

Favorable long-term outcome of patients with multiple myeloma using a frontline tandem approach with autologous and non-myeloablative allogeneic transplantation

“…It is well recognized that grades II-IV acute GvHD is associated with deleterious outcome and lower PFS and OS. 12,18,20,35,39 Conversely, the favorable impact of chronic GvHD on relapse is another important result. We speculate that the higher incidence of chronic GvHD observed in our cohort directly correlates with a GvMM effect and possibly explains the impressive PFS observed in our study.…”

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

“…21,22 It is of note that in the series with longest follow-up, including up-front and relapsed patients, the PFS is about 25% at 5 years and between 16 and 24% at 10 years and the OS about 55% at 5 years and from 30 to 40% at 10 years. 23,24 It is important to consider that this high-risk procedure is usually only offered to patients with the poorest short-term predicted outcome with conventional therapies. As a matter of fact, the number of patients undergoing allo-HCT for MM in institutions with a high-transplant activity is low and the published results usually come from registry studies rather than single institution series.…”