Non-myeloablative allogeneic
stem cell transplantation has been reported to induce sustained complete remission even in advanced
diseases (acute leukemia,
lymphomas). The tolerance of this procedure allows treatment of poor candidates to conventional
allogeneic transplantation with persisting or relapsing myeloma patients. Twelve patients previously treated with at least
VAD regimen and
autologous transplantation were included. All patients had a serum beta2 microglobuline >3 mg/l at diagnosis. The conditioning regimen consisted of
fludarabine 25 mg/m/day x 5,
antithymoglobulin 2.5 mg/kg/day x 5,
busulphan 2 mg/kg/day x 2; the transplant was peripheral stem cells (except one) from an HLA-matched sibling and was followed by
cyclosporin for 45 to 90 days. This treatment results in a well-tolerated procedure (no
mucositis, duration of aplasia <7 days). A dramatic graft anti-myeloma effect is documented even in progressive disease (11/12 PR + CR, 4/12 CR). However, five patients underwent CMV disease, one died of CMV
encephalitis (UPN 3) and delayed severe GVHD occurred in four patients. Our data suggest that a better survival could be achieved when patients are transplanted with a controlled disease. In high risk patients, we now propose a non-myeloablative
transplantation in addition to the conventional and intensive
chemotherapy as first-line of treatment.