Abstract
Allogeneic stem cell transplantation (allo-SCT) using reduced-intensity conditioning (RIC) is a feasible procedure in selected patients with relapsed multiple myeloma (MM), but its efficacy remains a matter of debate. The mortality and morbidity related to the procedure and the rather high relapse risk make the use of allo-SCT controversial. In addition, the availability of novel antimyeloma treatments, such as bortezomib and immunomodulatory agents, have made allo-SCT less appealing to clinicians. We investigated the role of RIC allo-SCT in patients with MM who relapsed after autologous stem cell transplantation and were then treated with a salvage therapy based on novel agents. This study was structured similarly to an intention-to-treat analysis and included only those patients who underwent HLA typing immediately after the relapse. Patients with a donor (donor group) and those without a suitable donor (no-donor group) were compared. A total of 169 consecutive patients were evaluated retrospectively in a multicenter study. Of these, 75 patients found a donor and 68 (91%) underwent RIC allo-SCT, including 24 from an HLA-identical sibling (35%) and 44 from an unrelated donor (65%). Seven patients with a donor did not undergo allo-SCT for progressive disease or concomitant severe comorbidities. The 2-year cumulative incidence of nonrelapse mortality was 22% in the donor group and 1% in the no-donor group (P <0001). The 2-year progression-free survival (PFS) was 42% in the donor group and 18% in the no-donor group (P <0001). The 2-year overall survival (OS) was 54% in the donor group and 53% in the no-donor group (P = 329). In multivariate analysis, lack of a donor was a significant unfavorable factor for PFS, but not for OS. Lack of chemosensitivity after salvage treatment and high-risk karyotype at diagnosis significantly shortened OS. In patients who underwent allo-SCT, the development of chronic graft-versus-host disease had a significant protective effect on OS. This study provides evidence for a significant PFS benefit of salvage treatment with novel drugs followed by RIC allo-SCT in patients with relapsed MM who have a suitable donor.
| Original language | English |
|---|---|
| Pages (from-to) | 617-626 |
| Number of pages | 10 |
| Journal | Biology of Blood and Marrow Transplantation |
| Volume | 18 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Apr 2012 |
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Keywords
- Donor versus no-donor analysis
- Novel drugs
- Reduced-intensity regimens
ASJC Scopus subject areas
- Transplantation
- Hematology
Cite this
Allogeneic stem cell transplantation in multiple myeloma relapsed after autograft : A multicenter retrospective study based on donor availability. / Patriarca, Francesca; Einsele, Hermann; Spina, Francesco; Bruno, Benedetto; Isola, Miriam; Nozzoli, Chiara; Nozza, Andrea; Sperotto, Alessandra; Morabito, Fortunato; Stuhler, Gernot; Festuccia, Moreno; Bosi, Alberto; Fanin, Renato; Corradini, Paolo.
In: Biology of Blood and Marrow Transplantation, Vol. 18, No. 4, 04.2012, p. 617-626.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Allogeneic stem cell transplantation in multiple myeloma relapsed after autograft
T2 - A multicenter retrospective study based on donor availability
AU - Patriarca, Francesca
AU - Einsele, Hermann
AU - Spina, Francesco
AU - Bruno, Benedetto
AU - Isola, Miriam
AU - Nozzoli, Chiara
AU - Nozza, Andrea
AU - Sperotto, Alessandra
AU - Morabito, Fortunato
AU - Stuhler, Gernot
AU - Festuccia, Moreno
AU - Bosi, Alberto
AU - Fanin, Renato
AU - Corradini, Paolo
PY - 2012/4
Y1 - 2012/4
N2 - Allogeneic stem cell transplantation (allo-SCT) using reduced-intensity conditioning (RIC) is a feasible procedure in selected patients with relapsed multiple myeloma (MM), but its efficacy remains a matter of debate. The mortality and morbidity related to the procedure and the rather high relapse risk make the use of allo-SCT controversial. In addition, the availability of novel antimyeloma treatments, such as bortezomib and immunomodulatory agents, have made allo-SCT less appealing to clinicians. We investigated the role of RIC allo-SCT in patients with MM who relapsed after autologous stem cell transplantation and were then treated with a salvage therapy based on novel agents. This study was structured similarly to an intention-to-treat analysis and included only those patients who underwent HLA typing immediately after the relapse. Patients with a donor (donor group) and those without a suitable donor (no-donor group) were compared. A total of 169 consecutive patients were evaluated retrospectively in a multicenter study. Of these, 75 patients found a donor and 68 (91%) underwent RIC allo-SCT, including 24 from an HLA-identical sibling (35%) and 44 from an unrelated donor (65%). Seven patients with a donor did not undergo allo-SCT for progressive disease or concomitant severe comorbidities. The 2-year cumulative incidence of nonrelapse mortality was 22% in the donor group and 1% in the no-donor group (P <0001). The 2-year progression-free survival (PFS) was 42% in the donor group and 18% in the no-donor group (P <0001). The 2-year overall survival (OS) was 54% in the donor group and 53% in the no-donor group (P = 329). In multivariate analysis, lack of a donor was a significant unfavorable factor for PFS, but not for OS. Lack of chemosensitivity after salvage treatment and high-risk karyotype at diagnosis significantly shortened OS. In patients who underwent allo-SCT, the development of chronic graft-versus-host disease had a significant protective effect on OS. This study provides evidence for a significant PFS benefit of salvage treatment with novel drugs followed by RIC allo-SCT in patients with relapsed MM who have a suitable donor.
AB - Allogeneic stem cell transplantation (allo-SCT) using reduced-intensity conditioning (RIC) is a feasible procedure in selected patients with relapsed multiple myeloma (MM), but its efficacy remains a matter of debate. The mortality and morbidity related to the procedure and the rather high relapse risk make the use of allo-SCT controversial. In addition, the availability of novel antimyeloma treatments, such as bortezomib and immunomodulatory agents, have made allo-SCT less appealing to clinicians. We investigated the role of RIC allo-SCT in patients with MM who relapsed after autologous stem cell transplantation and were then treated with a salvage therapy based on novel agents. This study was structured similarly to an intention-to-treat analysis and included only those patients who underwent HLA typing immediately after the relapse. Patients with a donor (donor group) and those without a suitable donor (no-donor group) were compared. A total of 169 consecutive patients were evaluated retrospectively in a multicenter study. Of these, 75 patients found a donor and 68 (91%) underwent RIC allo-SCT, including 24 from an HLA-identical sibling (35%) and 44 from an unrelated donor (65%). Seven patients with a donor did not undergo allo-SCT for progressive disease or concomitant severe comorbidities. The 2-year cumulative incidence of nonrelapse mortality was 22% in the donor group and 1% in the no-donor group (P <0001). The 2-year progression-free survival (PFS) was 42% in the donor group and 18% in the no-donor group (P <0001). The 2-year overall survival (OS) was 54% in the donor group and 53% in the no-donor group (P = 329). In multivariate analysis, lack of a donor was a significant unfavorable factor for PFS, but not for OS. Lack of chemosensitivity after salvage treatment and high-risk karyotype at diagnosis significantly shortened OS. In patients who underwent allo-SCT, the development of chronic graft-versus-host disease had a significant protective effect on OS. This study provides evidence for a significant PFS benefit of salvage treatment with novel drugs followed by RIC allo-SCT in patients with relapsed MM who have a suitable donor.
KW - Donor versus no-donor analysis
KW - Novel drugs
KW - Reduced-intensity regimens
UR - http://www.scopus.com/inward/record.url?scp=84858075401&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84858075401&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2011.07.026
DO - 10.1016/j.bbmt.2011.07.026
M3 - Article
C2 - 21820394
AN - SCOPUS:84858075401
VL - 18
SP - 617
EP - 626
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
SN - 1083-8791
IS - 4
ER -