Late relapses following reduced intensity allogeneic transplantation in patients with multiple myeloma: a long-term follow-up study.

Abstract

We analysed the long-term outcomes of 60 multiple myeloma patients who underwent reduced intensity allogeneic stem cell transplantation between August 2000 and March 2008. Regimens included fludarabine and melphalan conditioning (flu-mel regimen) for allogeneic haematopoietic cell transplant (HCT) or a planned tandem regimen consisting of high-dose melphalan conditioning for autograft followed by low-dose total body irradiation conditioning for allogeneic HCT (auto-allo regimen). Donors included human-leucocyte-antigen-matched siblings (n = 55) or matched unrelated donors (n = 5). With a median follow-up of 9·8 years, 7-year overall survival (OS) and progression-free survival (PFS) were 60% and 31%, respectively. By multivariate Cox regression analysis, disease status of complete response (CR) or partial response (PR) at transplant and the presence of chronic graft-versus-host disease were significantly associated with improved OS. Only disease status was significantly associated with improved PFS. We noted a surprising number of very late relapses, with six patients (10%) relapsing between 6 and 12 years post-transplant. Among the six late relapse patients, all were transplanted within 14 months of diagnosis, five had normal karyotypes, and five were in CR/PR. Our data provide additional evidence that, while survival may be extended by reduced intensity allogeneic transplant, ultimately, it may not offer a cure.

• Authors: Firoozeh Sahebi, Yan Shen, Sandra H Thomas, Amalia Rincon, Joyce Murata-Collins, Joycelynne Palmer, Amrita Y Krishnan, Chatchada Karanes, Myo Htut, George Somlo, Stephen J Forman
• Journal: British journal of haematology (Br J Haematol) Vol. 160 Issue 2 Pg. 199-206 (Jan 2013) ISSN: 1365-2141 [Electronic] England
• PMID: 23151215 (Publication Type: Evaluation Study, Journal Article, Research Support, N.I.H., Extramural)
• Copyright: © 2012 Blackwell Publishing Ltd.

Chemical References

• Vidarabine
• fludarabine
• Melphalan

Topics

• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Bone Marrow Transplantation (statistics & numerical data)
• Combined Modality Therapy
• Female
• Follow-Up Studies
• Graft vs Host Disease (epidemiology)
• Humans
• Kaplan-Meier Estimate
• Living Donors
• Male
• Melphalan (administration & dosage)
• Middle Aged
• Multiple Myeloma (drug therapy, genetics, mortality, surgery)
• Peripheral Blood Stem Cell Transplantation (statistics & numerical data)
• Proportional Hazards Models
• Recurrence
• Remission Induction
• Retrospective Studies
• Time Factors
• Transplantation Conditioning (methods)
• Transplantation, Autologous
• Transplantation, Homologous
• Treatment Outcome
• Vidarabine (administration & dosage, analogs & derivatives)
• Whole-Body Irradiation