Progress in allogeneic bone marrow and peripheral blood stem cell transplantation for multiple myeloma: a comparison between transplants performed 1983–93 and 1994–98 at European Group for Blood and Marrow Transplantation centres

Abstract

Out of 690 allogeneic matched sibling donor transplants for multiple myeloma reported to the European Group for Blood and Marrow Transplantation (EBMT) registry, 334 were performed during the period 1983–93 (all with bone marrow) and 356 during 1994–98 [223 with bone marrow and 133 with peripheral blood stem cells (PBSCs)]. The median overall survival was 10 months for patients transplanted during the earlier time period and 50 months for patients transplanted with bone marrow during the later period. The use of PBSCs was associated with earlier engraftment but no significant survival benefit compared to bone marrow transplants during the same time period. The improvement in survival since 1994 was the result of a significant reduction in transplant‐related mortality, which was 38%, 21% and 25% at 6 months and 46%, 30% and 37% at 2 years during the earlier period, and the later period with bone marrow and PBSCs respectively. Reasons for the reduced transplant‐related mortality appeared to be fewer deaths owing to bacterial and fungal infections and interstitial pneumonitis, in turn a result of earlier transplantation and less prior chemotherapy. Better supportive treatment and more frequent use of cytokines may also play a role. The improvement in survival was not directly related to the increased use of PBSCs.

Allogenic hematopoietic stem‐cell transplantation with reduced‐intensity conditioning in patients with refractory and recurrent multiple myeloma

“…Plateau in the range of 30% to 40% of patients was consistently shown in these studies, years after SCT. [8][9][10][11][12][13] In the Southwest Oncology Group SWOG9321 randomized trial, patients with a donor received myeloablative SCT. The 7-year OS and PFS rates were 39% and 22%, respectively.…”

“…9 Later EBMT studies demonstrated improvement in NRM rates in more recent years, mostly due to better patient selection, but possibly due to improvement in supportive care, yet this has not led to wider use of this approach. 11,15 RIC regimens were developed to reduce NRM rates and to allow allogeneic SCT in elderly and medically infirm patients. 29 RIC rapidly became a promising approach to investigate in myeloma, for which NRM was historically a major limiting factor.…”

Role of Allogeneic Stem Cell Transplantation in Multiple Myeloma

“…The largest retrospective multi-center analysis by the European Bone Marrow Transplant (EBMT) registry showed a remarkable improvement in survival in the late 1990s due to a reduction in transplant-related mortality through improved supportive care and more careful patient selection. 31 In this study, 690 patients, with a median age at transplant of 44 years, who underwent a myeloablative allograft were divided into two cohorts: patients who received a bone marrow allograft between 1983-1993 and those grafted between 1994-1998. In the latter cohort, some patients also received granulocyte colony-stimulating factor (G-CSF) mobilized peripheral blood hematopoietic cells (PBHCs).…”

High‐dose therapy and autologous peripheral blood stem cells transplantation followed by a very low reduced intensity regimen with fludarabine + cyclophosphamide and allograft improve complete remission rate in de novo multiple myeloma patients

“…The possible advantage of allogeneic transplantation is a well-proven graft-versus-myeloma (GVM) effect by immunocompetent donor lymphocytes [7][8][9]. However, despite a better control of infectious complications and graft-versus-host disease (GVHD), the treatment-related mortality (TRM) rate of allogeneic transplantation is still 15-40% [10][11][12]. Therefore, allogeneic transplantation is only an option for younger patients with an HLA-identical sibling.…”