Long-term outcome after allogeneic stem-cell transplantation with reduced-intensity conditioning in patients with multiple myeloma

  • J. E
  • R. C
  • S. F
 et al. 
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Abstract

This study examines the long-term outcomes of a cohort of patients with myeloma who were treated with reduced-intensity conditioning (RIC) regimens after a minimum follow-up of 5 years at our centre. A total of 53 patients with multiple myeloma (MM) who received allogeneic hematopoietic stem-cell transplantation (Allo-SCT) between January 2000 and January 2007 were identified. The median follow-up of living patients was 84 months (51-141). The median age of the MM patients was 50 (28-70) years. Fifty-one patients (96%) received a transplant from a sibling donor. The median time between diagnosis and Allo-SCT was 34 months (6-161), and the median time between auto-SCT and Allo-SCT was 10 months (1-89). Fifty-one patients (96%) received at least one auto-SCT; 24 patients (45%) received a tandem auto-Allo-SCT. At last follow-up, 21 patients (40%) are alive >5 years post RIC Allo-SCT. At last follow-up, 14 (26%) are in first complete remission (CR), and four patients (8%) in second CR after donor lymphocyte infusion or re-induction with one of the new anti-myeloma drugs (bortezomib or lenalidomide) after Allo-SCT. Eight patients (38%) among these long survivors received one of these new drugs as induction or relapse treatment before Allo-SCT. Disease status and occurrence of cGvHD were significantly associated with progression-free survival (PFS); hazard ratio (HR)=0.62 (0.30-1.29, P=0.20). Acute GvHD was correlated with higher transplant-related mortality; HR=4.19 (1.05-16.77, P=0.04). No variables were associated with overall survival (OS). In conclusion, we observe that long-term disease control can be expected in a subset of MM patients undergoing RIC Allo-SCT. After 10 years, the OS and PFS were 32% and 24%, respectively. The PFS curve after Allo-SCT stabilizes in time with a plateau after 6 years post Allo-SCT. 2013 Wiley Periodicals, Inc.

Author-supplied keywords

  • *Hematopoietic Stem Cell Transplantation/ae [Adver
  • *Multiple Myeloma/th [Therapy]
  • *Transplantation Conditioning
  • *allogeneic stem cell transplantation
  • *multiple myeloma/dt [Drug Therapy]
  • *multiple myeloma/th [Therapy]
  • *reduced intensity conditioning
  • Adult
  • Aged
  • Autologous
  • Cohort Studies
  • Follow-Up Studies
  • France/ep [Epidemiology]
  • Graft vs Host Disease/mo [Mortality]
  • Graft vs Host Disease/pc [Prevention & Control]
  • Graft vs Host Disease/pp [Physiopathology]
  • Homologous
  • Humans
  • Incidence
  • Middle Aged
  • Multiple Myeloma/di [Diagnosis]
  • Multiple Myeloma/pa [Pathology]
  • Neoplasm Staging
  • Prognosis
  • Remission Induction
  • Retrospective Studies
  • Severity of Illness Index
  • Siblings
  • Survival Analysis
  • Transplantation
  • Transplantation Conditioning/ae [Adverse Effects]
  • adult
  • aged
  • article
  • bortezomib/dt [Drug Therapy]
  • cancer prognosis
  • cancer recurrence
  • cancer regression
  • cancer survival
  • chronic graft versus host disease/co [Complication
  • cohort analysis
  • donor lymphocyte infusion
  • female
  • human
  • lenalidomide/dt [Drug Therapy]
  • major clinical study
  • male
  • mortality
  • outcome assessment
  • overall survival
  • priority journal
  • progression free survival
  • retrospective study
  • sibling

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Authors

  • El-Cheikh J.

  • Crocchiolo R.

  • Furst S.

  • Stoppa A.-M.

  • Ladaique P.

  • Faucher C.

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