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 Blood, 2 April 2009, Vol. 113, No. 14, pp. 3383-3391.
Prepublished online as a Blood First Edition Paper on November 17, 2008; DOI 10.1182/blood-2008-07-170746.

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TRANSPLANTATION

Long-term outcome of patients with multiple myeloma after autologous hematopoietic cell transplantation and nonmyeloablative allografting

Marcello Rotta1, Barry E. Storer1,2, Firoozeh Sahebi3, Judith A. Shizuru4, Benedetto Bruno5, Thoralf Lange6, Edward D. Agura7, Peter A. McSweeney8, Michael A. Pulsipher9, Parameswaran Hari10, Richard T. Maziarz11, Thomas R. Chauncey12, Frederick R. Appelbaum1,2, Mohamed L. Sorror1, William Bensinger1,2, Brenda M. Sandmaier1,2, Rainer F. Storb1,2, and David G. Maloney1,2

1 Fred Hutchinson Cancer Research Center, Seattle, WA; 2 University of Washington, Seattle; 3 City of Hope National Medical Center/Southern California Kaiser Permanente Medical Group, Duarte, CA; 4 Stanford University, CA; 5 University of Turin, Turin, Italy; 6 University of Leipzig, Leipzig, Germany; 7 Baylor University, Dallas, TX; 8 Rocky Mountain Cancer Center, Denver, CO; 9 University of Utah, Salt Lake City; 10 Medical College of Wisconsin, Milwaukee; 11 Oregon Health & Science University, Portland; and 12 Puget Sound VA Medical Center, Seattle, WA

Autologous hematopoietic cell transplantation (HCT) followed by nonmyeloablative allogeneic HCT (auto/alloHCT) provides cytoreduction and graft-versus-myeloma effects. We report on long-term outcomes of 102 patients with multiple myeloma who received auto/alloHCT with a median follow-up of 6.3 years. Treatment consisted of high-dose melphalan and autograft followed by 2-Gy total body irradiation, with or without fludarabine, and alloHCT from human leukocyte antigen-identical siblings. Postgrafting immunosuppressive agent was cyclosporine or tacrolimus and mycophenolate mofetil. Forty-two percent of patients developed grade 2 to 4 acute graft-versus-host disease (GVHD) and 74% extensive chronic GVHD. Five-year nonrelapse mortality after allografting was 18%, 95% related to GVHD or infections. Among 95 patients with detectable disease, 59 achieved complete remissions. Median time to progression was 5 years. Median overall survival (OS) was not reached. Median progression-free survival (PFS) was 3 years. Five-year OS and PFS were 64% and 36%, respectively. Seventy-three patients receiving autoHCT within 10 months from treatment initiation had 5-year OS of 69% and PFS of 37%. In multivariate analysis, β-2-microglobulin of more than 3.5 µg/mL at diagnosis and auto/alloHCT more than 10 months after treatment initiation correlated with shorter OS (P = .03 and P = .02) and PFS (P = .04 and P = .03), whereas Karnofsky scores less than 90% at allotransplantation correlated with shorter PFS only (P = .005). Long-term disease control and GVHD remain key issues.


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Related Article in Blood Online:

Reduced-intensity allogeneic transplantation for myeloma: reality bites
A. Keith Stewart
Blood 2009 113: 3135-3136. [Full Text] [PDF]



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A. K. Stewart
Reduced-intensity allogeneic transplantation for myeloma: reality bites
Blood, April 2, 2009; 113(14): 3135 - 3136.
[Full Text] [PDF]


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