Reduced-Intensity Allogeneic Hematopoietic Stem Cell Transplantation for Relapsed Multiple Myeloma

Abstract

Purpose Despite recent advances, multiple myeloma remains incurable and most patients eventually develop progressive disease. Allogeneic hematopoietic stem cell transplantation (allo HCT) offers a potentially curative option in 10–20% of patients with relapsed or refractory disease. We evaluated the outcome of patients undergoing allo HCT with reduced-intensity conditioning (RIC) for relapsed and/or refractory myeloma at our institution. Methods Fifty-one patients with heavily pretreated, relapsed myeloma, who received RIC allo HCT between 1996 and 2006, were included in this analysis. Results Median time from diagnosis to allo HCT was 34 months. Median follow-up in surviving patients was 27 months (3–98). Cumulative transplant-related mortality (TRM) at 1 year was 25%. Progression-free survival (PFS) and overall survival (OS) at 2 years were 19% and 32%, respectively. The incidence of grade II-IV acute or chronic graft-vs-host disease (GVHD) was 27% and 47%, respectively. At the time of this analysis, 12 patients (24%) were alive 7 of whom (14%) were in remission for up to 6 years after allo SCT. A lower β2 microglobulin (<3.3) and a prior autotransplant predicted a lower NRM, longer PFS and OS. Conclusion Allo HCT with RIC regimens is associated with acceptable toxicity and durable remission and survival in relapsed or refractory myeloma. Use of RIC allo HCT earlier in the course of the disease may offer greater benefit.

Allogeneic hematopoietic cell transplant for multiple myeloma using reduced intensity conditioning therapy, 1998–2006: factors associated with improved survival outcome

“…Rotta et al [21] and a recent study from the M. D. Anderson Center [22] found that high b 2microglobulin levels were an adverse risk factor for overall and progression-free survival; this factor was excluded from analysis in our study due to the relatively high level of non-response to this question. Our study also confirmed previous findings that recipients with an HLA-identical sibling donor had a significant survival advantage over those with other donor types [23,24].…”

Autologous/reduced-intensity allogeneic stem cell transplantation vs autologous transplantation in multiple myeloma: long-term results of the EBMT-NMAM2000 study

“…The present study does not provide an answer to this question. However, other studies, [19][20][21] including a retrospective EBMT study that is in progress, indicate that allogeneic transplantation might be an option. Still, these studies are not prospective and do not compare results with those of new drug treatment or autologous transplantation.…”

A Randomized Phase II Trial of Fludarabine/Melphalan 100 versus Fludarabine/Melphalan 140 Followed by Allogeneic Hematopoietic Stem Cell Transplantation for Patients with Multiple Myeloma

“…We and others have shown that purine analog containing non-myeloablative chemotherapy enables engraftment of allogeneic hematopoietic progenitor cells (HPC) in patients considered ineligible for myeloablative therapy due to age or medical illness 6–8 . We have previously shown that RIC allo-HCT is associated with durable remission and survival in selected patients with relapsed or refractory MM 9 . In that study of heavily pre-treated patients, progression-free survival (PFS) and OS at 2-years were 19% and 32%, respectively and 24% of patients were still alive after a median follow-up of 27 months.…”