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Allogeneic bone marrow transplantation versus autologous stem cell
transplantation in multiple myeloma: a retrospective case-matched study
from the European Group for Blood and Marrow Transplantation
BB Bjorkstrand, P Ljungman, H Svensson, J Hermans, A Alegre, J Apperley, J Blade, K Carlson, M Cavo, A Ferrant, AH Goldstone, A de Laurenzi, I Majolino, R Marcus, HG Prentice, K Remes, D Samson, A Sureda, LF Verdonck, L Volin and G Gahrton
Department of Medicine, Karolinska Institute and Huddinge Hospital, Sweden.
A retrospective case-matched analysis was performed comparing 189 myeloma
patients treated with allogeneic bone marrow transplantation (allo-BMT)
with an equal number of patients who received autologous stem cell
transplantation (ASCT). Matching was performed with respect to gender and
number of treatment lines before transplantation. The groups were
comparable with the exception of median age (43 years for allo-BMT v 49
years for ASCT, P = .0001) and median posttransplant follow-up (46 months
for allo-BMT v 30 months for ASCT, P = .0003). The overall survival was
significantly better for ASCT than for allo-BMT, with a median survival of
34 months and 18 months, respectively (P = .001). However, this survival
advantage was only observed in men, but not in women. The statistically
significant survival advantage for ASCT was seen in most subgroups, ie,
chemotherapy-responsive patients, patients who had received two or more
treatment lines before transplantation, patients in partial remission,
patients with an IgG- subtype, patients older than 46 years of age,
patients with stage II disease, and patients with a low or high
serum-beta-2-microglobulin at diagnosis. The main reason for the poorer
survival in allo-BMT patients was higher transplant-related mortality (41%
v 13% for ASCT, P = .0001), which was not compensated for by a lower rate
of relapse and progression. However, in patients alive at 1 year
posttransplant, there was a trend for better long-term survival (P = .09)
and significantly better progression-free survival (P = .02) for allo-BMT
as compared with ASCT. We conclude that the median survival is superior for
ASCT. However, allo-BMT has a lower relapse rate, which results in a
similar long-term outcome for both approaches, but a longer follow-up is
needed to assess the final outcome.
Volume 88,
Issue 12,
pp. 4711-4718,
12/15/1996
Copyright © 1996 by The American Society of Hematology
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