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Monoclonal antibody-purged bone marrow transplantation therapy for multiple
myeloma
KC Anderson, J Andersen, R Soiffer, AS Freedman, SN Rabinowe, MJ Robertson, N Spector, K Blake, C Murray and A Freeman
Division of Tumor Immunology, Dana-Farber Cancer Institute, Boston, MA
02115.
Forty patients with plasma cell dyscrasias underwent high-dose
chemoradiotherapy and either anti-B-cell monoclonal antibody (MoAb)-
treated autologous, anti-T-cell MoAb-treated HLA-matched sibling allogeneic
or syngeneic bone marrow transplantation (BMT). The majority of patients
had advanced Durie-Salmon stage myeloma at diagnosis, all were pretreated
with chemotherapy, and 17 had received prior radiotherapy. At the time of
BMT, all patients demonstrated good performance status with Karnofsky score
of 80% or greater and had less than 10% marrow tumor cells; 34 patients had
residual monoclonal marrow plasma cells and 38 patients had paraprotein.
Following high-dose chemoradiotherapy, there were 18 complete responses
(CR), 18 partial responses, one non-responder, and three toxic deaths.
Granulocytes greater than 500/microL and untransfused platelets greater
than 20,000/microL were noted at a median of 23 (range, 12 to 46) and 25
(range, 10 to 175) days posttransplant (PT), respectively, in 24 of the 26
patients who underwent autografting. In the 14 patients who received
allogeneic or syngeneic grafts, granulocytes greater than 500/microL and
untransfused platelets greater than 20,000/microL were noted at a median of
19 (range, 12 to 24) and 16 (range, 5 to 32) days PT, respectively. With 24
months median follow-up for survival after autologous BMT, 16 of 26
patients are alive free from progression at 2+ to 55+ months PT; of these,
5 patients remain in CR at 6+ to 55+ months PT. With 24 months median
follow-up for survival after allogeneic and syngeneic BMT, 8 of 14 patients
are alive free from progression at 8+ to 34+ months PT; of these, 5
patients remain in CR at 8+ to 34+ months PT. This therapy has achieved
high response rates and prolonged progression-free survival in some
patients and proven to have acceptable toxicity. However, relapses
post-BMT, coupled with slow engraftment post-BMT in heavily pretreated
patients, suggest that such treatment strategies should be used earlier in
the disease course. To define the role of BMT in the treatment of myeloma,
its efficacy should be compared with that of conventional chemotherapy in a
randomized trial.
Volume 82,
Issue 8,
pp. 2568-2576,
10/15/1993
Copyright © 1993 by The American Society of Hematology
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