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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. This Article Full Text (PDF) Supplemental Table All Versions of this Article: blood-2008-07-170746v1 113/14/3383    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 Rotta, M. Articles by Maloney, D. G. Search for Related Content PubMed PubMed Citation Articles by Rotta, M. Articles by Maloney, D. G. Related Collections Related Article in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted July 28, 2008 Accepted November 9, 2008 Long-term outcome of patients with multiple myeloma after autologous hematopoietic cell transplantation and nonmyeloablative allografting Marcello Rotta, Barry E Storer, Firoozeh Sahebi, Judith A. Shizuru, Benedetto Bruno, Thoralf Lange, Edward D. Agura, Peter A. McSweeney, Michael A Pulsipher, Parameswaran Hari, Richard T. Maziarz, Thomas R. Chauncey, Frederick R. Appelbaum, Mohamed L. Sorror, William Bensinger, Brenda M. Sandmaier, Rainer F. Storb, and David G. Maloney* Fred Hutchinson Cancer Research Center, Seattle, WA, United States University of Washington, Seattle, WA, United States City Of Hope National Medical Center/So. California Kaiser Permanente Medical Group, Duarte, CA, United States Stanford University, Stanford, CA, United States University of Torino, Torino, Italy University of Leipzig, Leipzig, Germany Baylor University, Waco, TX, United States Rocky Mountain Cancer Center, Denver, CO, United States University of Utah, Salt Lake City, UT, United States Medical College of Wisconsin, Milwaukee, WI, United States Oregon Health & Science University, Portland, OR, United States Puget Sound VA Medical Center, Seattle, WA, United States * Corresponding author; email: dmaloney{at}fhcrc.org. 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, ± fludarabine and AlloHCT from HLA-identical siblings. Postgrafting immunosuppression was cyclosporine or tacrolimus and mycophenolate mofetil. Forty-two percent of patients developed grade 2-4 acute graft-versus-host-disease (GVHD) and 74% extensive chronic GVHD. Five-year non-relapse 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, beta-2-microglobulin >3.5 µg/mL at diagnosis and Auto/AlloHCT >10 months after treatment initiation correlated with shorter OS (p=0.03 and p=0.02) and PFS (p=0.04 and p=0.03), while Karnofsky scores <90% at allotransplant correlated with shorter PFS only (p=0.005). Long-term disease control and GVHD remain key issues. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Article in Blood Online: Reduced-intensity allogeneic transplantation for myeloma: reality bites A. Keith Stewart Blood 2009 113: 3135-3136. [Full Text] [PDF] This article has been cited by other articles: 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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