Impact of high-risk cytogenetics and achievement of molecular remission on long-term freedom from disease after autologous-allogeneic tandem transplantation in patients with multiple myeloma.

Abstract

Within a prospective protocol, the incidence and impact of achievement of molecular remission (mCR) and high-risk cytogenetics was investigated in 73 patients with multiple myeloma (MM) after autologous (auto)-allogeneic (allo) tandem stem cell transplantation (SCT). After induction chemotherapy, patients received melphalan 200 mg/m(2) before undergoing auto-SCT, followed 3 months later by melphalan 140 mg/m(2) and fludarabine 180 mg/m(2) before allo-SCT. Sixteen patients had high-risk cytogenetic features, defined by positive FISH for del(17p13) and/or t(4;14). Overall, 66% of the patients achieved CR or near-CR, and 41% achieved mCR, which was sustained negative (at least 4 consecutive samples negative) in 15 patients (21%), with no significant difference in incidence between the patients with high-risk cytogenetics and others (P = .70). After a median follow-up of 6 years, overall 5-year progression-free survival was 29%, with no significant difference between del 17p13/t(4;14)-harboring patients and others (24% versus 30%; P = .70). The 5-year progression-free survival differed substantially according to the achieved remission: 17% for partial remission, 41% for CR, 57% for mCR, and 85% for sustained mCR. These results suggest that auto-allo tandem SCT may overcome the negative prognostic effect of del(17p13) and/or t(4;14) and that achievement of molecular remission resulted in long-term freedom from disease.

• Authors: Nicolaus Kröger, Anita Badbaran, Tatjana Zabelina, Francis Ayuk, Christine Wolschke, Haefaa Alchalby, Evgeny Klyuchnikov, Djordje Atanackovic, Georgia Schilling, Timon Hansen, Sabine Schwarz, Marion Heinzelmann, Silke Zeschke, Ulrike Bacher, Thomas Stübig, Boris Fehse, Axel R Zander
• Journal: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 19 Issue 3 Pg. 398-404 (Mar 2013) ISSN: 1523-6536 [Electronic] United States
• PMID: 23078786 (Publication Type: Journal Article)
• Copyright: Copyright © 2013. Published by Elsevier Inc.

Chemical References

• Myeloablative Agonists
• Vidarabine
• fludarabine
• Melphalan

Topics

• Adult
• Cytogenetic Analysis
• Disease-Free Survival
• Female
• Hematopoietic Stem Cell Transplantation (methods)
• Humans
• Male
• Melphalan (pharmacology, therapeutic use)
• Middle Aged
• Multiple Myeloma (genetics, mortality, pathology, therapy)
• Myeloablative Agonists (pharmacology, therapeutic use)
• Prognosis
• Prospective Studies
• Remission Induction (methods)
• Translocation, Genetic
• Transplantation Conditioning
• Transplantation, Autologous
• Transplantation, Homologous
• Treatment Outcome
• Vidarabine (analogs & derivatives, pharmacology, therapeutic use)