The outcome of unrelated donor stem cell transplantation for patients with multiple myeloma

Abstract

Summary. We performed a retrospective analysis of outcome in 45 patients with multiple myeloma receiving unrelated donor stem cell transplants (UD-SCT) in the UK between 1993 and 2002; 17 received myeloablative conditioning regimens and 28 received reduced intensity conditioning (RIC) protocols. Forty patients received pretransplant CAMPATH serotherapy. Forty-two of 45 patients had detectable disease at transplant, but 33 of 45 were chemoresponsive. Sixty per cent of patients had received a previous autograft. Myeloid engraftment was seen in 95% of recipients and was significantly faster in recipients receiving peripheral blood stem cells (P ¼ 0AE07) and RIC (P ¼ 0AE001). The incidence of severe (grade 3/4) acute graft versus host disease (aGvHD) was 5% (2/40). The 100-d nonrelapse mortality was 18% (5/38) following RIC and 53% (9/17) following myeloablative regimens. Twenty-nine per cent of patients achieved a complete remission, 61% a partial remission, giving a 90% overall response rate. At median follow-up (513 d), overall survival was 40%: 54% in the RIC group (median follow-up: 489 d) and 18% in the myeloablative group (median follow-up: 560 d). In recipients of UD-SCT, RIC protocols that incorporated CAMPATH were associated with faster myeloid engraftment, less severe aGvHD and lower 100-d non-relapse mortality than myeloablative regimens, without a corresponding rise in relapse rate during the period of observation.

Nonmyeloablative and Reduced-Intensity Conditioning for Allogeneic Hematopoietic Stem Cell Transplantation

“…Shaw et al, 77 from the United Kingdom retrospectively compared data from 17 patients who received myeloablative allogeneic SCT with data from 28 patients who received RIC regimens before allogeneic SCT. Sixty percent of patients had previously received high-dose melphalan and autologous transplant.…”

In pursuit of the allo-immune response in multiple myeloma: where do we go from here?

“…The improvement in volunteer unrelated donor full-intensity AlloSCT outcomes represents a future development but, at present, should only be considered as part of a clinical trial protocol (see also British Society for BMT indication table: http://www.bsbmt.org/cms_pages/64-Indications- Table). 33 The role of RIC MUD AlloSCT remains to be defined although recent results have reported a TRM of B20%. 33,34 Clearly, further prospective trials are warranted to better define the role of RIC MUD Allo SCT for patients in the first treatment phase for myeloma.…”

“…33 The role of RIC MUD AlloSCT remains to be defined although recent results have reported a TRM of B20%. 33,34 Clearly, further prospective trials are warranted to better define the role of RIC MUD Allo SCT for patients in the first treatment phase for myeloma. Similarly, the use of umbilical cord stem cells as a source for GvM has been reported in a limited number of case reports, but only in patients with advanced disease, 39,40 and again should be explored only as part of a clinical study protocol.…”

“…32 In general, outcomes with matched unrelated donor (MUD) AlloSCT have improved with time and, in many settings, have become equivalent to matched sibling transplantation. However, retrospective studies in myeloma have shown a significantly higher TRM than sibling AlloSCT, 33 and myeloablative MUD AlloSCT is currently not recommended and should only be carried out in the context of prospective clinical trials. However, the role of RIC MUD AlloSCT remains to be defined.…”

High-dose chemotherapy with autologous stem cell rescue for relapse after allo-SCT in multiple myeloma

“…1 On the other hand, the role of allo-SCT is yet to be established; although it can induce molecular remission, treatment-related morbidity and mortality are high especially with myeloablative regimens. 2 Allo-SCTs with nonmyeloablative regimens have been offered in clinical trials to selected younger patients including those with high-risk disease features such as deletion of chromosome 13 and high b-2 microglobulin levels. 3 We report a 48-year-old African-American woman who initially presented in June 1999 with right shoulder pain and a pathologic humeral fracture, which was proven to be a plasmacytoma on biopsy.…”