Predictors of prolonged survival after allogeneic hematopoietic stem cell transplantation for multiple myeloma

✍ Scribed by Qaiser Bashir; Hassan Khan; Robert Z. Orlowski; Ali Imran Amjad; Nina Shah; Simrit Parmar; Wei Wei; Gabriela Rondon; Donna M. Weber; Michael Wang; Sheeba K. Thomas; Jatin J. Shah; Sofia R. Qureshi; Yvonne T. Dinh; Uday Popat; Paolo Anderlini; Chitra Hosing; Sergio Giralt; Richard E. Champlin; Muzaffar H. Qazilbash

• Publisher: John Wiley and Sons
• Year: 2012
• Tongue: English
• Weight: 746 KB
• Volume: 87
• Category: Article
• ISSN: 0361-8609
• DOI: 10.1002/ajh.22273

✦ Synopsis

Abstract

A total of 149 patients with multiple myeloma (MM) who received allogeneic hematopoietic stem cell transplantation (allo‐HCT) with myeloablative (MAC; n = 38) or reduced‐intensity conditioning (RIC; n = 110) regimens at MD Anderson Cancer Center were evaluated. Of the total, 120 (81%) patients had relapsed or had refractory disease. Median age of MM patients was 50 (28–70) years with a followup time of 28.5 (3–164) months. The 100‐day and 5‐year treatment related mortality (TRM) rates were 17% and 47%, respectively. TRM was significantly lower with RIC regimens (13%) vs. 29% for MAC at 100 days (P = 0.012). The cumulative incidence of Grade II–IV acute graft‐versus‐host disease (GVHD) was 35% and chronic GVHD was 46%. PFS and OS at 5 years were 15% and 21%, respectively. In multivariate analysis, allo‐HCT for primary remission consolidation was associated with longer PFS (HR 0.35; 95% CI, 0.18–0.67) and OS (HR 0.29; 95% CI 0.15–0.55), while absence of high‐risk cytogenetics was associated with longer PFS only (HR 0.59; 95% CI 0.37–0.95). We observe that TRM has decreased with the use of RIC regimens, and long‐term disease control can be expected in a subset of MM patients undergoing allo‐HCT. Further studies should be conducted in carefully designed clinical trials in this patient population. Am. J. Hematol., 2012. © 2011 Wiley Periodicals, Inc.