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Prepublished online as a Blood First Edition Paper on July 10, 2003; DOI 10.1182/blood-2002-09-2955. This Article Full Text (PDF) All Versions of this Article: 2002-09-2955v1 102/9/3447    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Maloney, D. G Articles by Storb, R. Search for Related Content PubMed PubMed Citation Articles by Maloney, D. G Articles by Storb, R. Social Bookmarking                   What's this? Submitted September 27, 2002 Accepted June 19, 2003 Allografting with non-myeloablative conditioning following cytoreductive autografts for the treatment of patients with multiple myeloma David G Maloney*, Arthur J Molina, Firoozeh Sahebi, Keith E Stockerl-Goldstein, Brenda M Sandmaier, William Bensinger, Barry Storer, Ute Hegenbart, George Somlo, Thomas Chauncey, Benedetto Bruno, Frederick R Appelbaum, Karl G Blume, Stephen J Forman, Peter McSweeney, and Rainer Storb Fred Hutchinson Cancer Research Center, Seatttle, WA, USA; University of Washington, Seattle, WA, USA VA Medical Center, Seattle, WA, USA City of Hope National Medical Center, Duarte, CA, USA Stanford University Medical Center, Stanford, CA, USA University of Colorado, Denver, CO, USA University of Leipzig, Germany University of Torino, Italy * Corresponding author; email: dmaloney{at}fhcrc.org. The full potential of a graft-versus-myeloma effect after allogeneic hematopoietic cell transplantation (HCT) for patients with multiple myeloma (MM) has not been realized because of excessive early transplant-related mortality (TRM) with conventional HCT. Autologous HCTs have been characterized by almost universal disease recurrences. The current trial combined autologous HCT with subsequent non-myeloablative allogeneic HCT to maintain the benefits of both approaches with acceptable toxicity. Fifty-four patients, 52 years (median, range 29-71) old, with previously treated stage II or III MM (52% refractory or relapsed disease) were given melphalan 200 mg/m2 and autologous HCT. Regimen-related toxicities after autologous HCT were moderate with a median of 6 days of neutropenia, 7 days of hospitalization, and one death from infection. Forty to 229 days later (median 62), 52 patients received a single fraction dose of 2 Gy total body irradiation and HCT from HLA-identical siblings with postgrafting immunosuppression with mycophenolate mofetil (MMF) and cyclosporine (CSP). Patients experienced medians of 0 days of hospitalization, neutropenia, and thrombocytopenia. Sustained engraftment was uniform. With a median follow-up of 552 days after allografting, overall survival is 78%. One patient (2%) died before day-100 from disease progression. Thirty-eight percent of patients developed acute GVHD (grade II in all but 4 cases) and 46% chronic GVHD requiring therapy. Tumor responses occurred slowly. Thus far, 57% of patients have achieved complete remissions and 26% partial remissions for an overall response of 83%. Despite being evaluated in elderly patients with MM, this two-step approach has reduced the acute toxicities of allogeneic HCT while achieving potent anti-tumor activities. 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