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Blood, 1 May 2001, Vol. 97, No. 9, pp. 2574-2579
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
High response rate in refractory and poor-risk multiple myeloma
after allotransplantation using a nonmyeloablative conditioning
regimen and donor lymphocyte infusions
Ashraf Badros,
Bart Barlogie,
Christopher Morris,
Raman Desikan,
Sara R. Martin,
Nikhil Munshi,
Maurizio Zangari,
Jayesh Mehta,
Amir Toor,
Michele Cottler-Fox,
Athanasios Fassas,
Elias Anaissie,
Steven Schichman, and
Guido Tricot
From the Myeloma and Transplantation Research Center
and Department of Pathology, University of Arkansas for Medical
Sciences and Veterans Health System, Little Rock, AR.
Standard allogeneic stem cell transplant (allo-SCT)
regimens have been associated with a high transplant-related mortality (TRM) in multiple myeloma (MM). Nonmyeloablative therapy can establish stable engraftment after allo-SCT and maintain the antitumor effect with less toxicity, which is important in heavily pretreated and elderly patients. We report on 16 poor-risk MM patients receiving allo-SCT from an HLA-matched (n = 14) or mismatched (n = 2) sibling following conditioning with melphalan 100 mg/m2 (MEL-100).
Ten patients had refractory relapse, 4 responsive relapse, and 2 patients were in near complete remission (nCR) with poor-prognosis
disease. Patients had received 1 (n = 9) or 2 (n = 7) prior
autotransplants. Donor lymphocyte infusions (DLIs) were given to 14 patients with no clinical evidence of graft versus host disease (GVHD)
either to attain full donor chimerism (n = 4) or to eradicate
residual disease (n = 10). Fifteen patients showed myeloid
engraftment, and 12 patients were full donor chimeras at day +21. No
TRM was observed during the first 100 days. Acute GVHD developed in 10 patients; 1 had fatal grade IV GVHD. Seven progressed to chronic GVHD,
limited in 3 and extensive in 4 patients. At a median follow-up of 1 year, 5 patients achieved and sustained CR, 3 nCR, and 4 partial
remission. Of 4 patients progressing after transplantation, 3 achieved
a remission following further chemotherapy and DLI. Remarkable graft
versus myeloma responses were seen in chemotherapy-refractory patients.
Two patients died of progressive disease, and 3 died of GVHD
complications without active disease. GVHD remains a major problem with
this procedure.
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