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Plasma Cell Disorders

Allogeneic stem cell transplantation and subsequent treatments as a comprehensive strategy for long-term survival of multiple myeloma patients

Bone Marrow Transplantation volume 52, pages 1602–1608 (2017)Cite this article

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Abstract

We evaluated 71 patients treated with allogeneic hematopoietic cell transplantation (allo-HCT) for multiple myeloma (MM). Forty-three patients (61%) received allo-HCT after the first line of therapy. Fifty-eight patients (82%) had chemosensitive disease at the time of allo-HCT. A HLA-matched related or unrelated donor was available for 68 patients (96%). Non-myeloablative or reduced-intensity conditioning regimen and peripheral blood hematopoietic cells as a graft source were used in most patients. The cumulative incidence of grade II–IV acute GVHD at day +100 and chronic GVHD at 5 years was 13% (95% CI 7–23%) and 35% (95% CI 24–46), respectively. Non-relapse mortality and relapse/progression incidence at 5 years were 12% (95% CI 5–23) and 65% (95% CI 49–76), respectively. With a median follow-up in survivors of 100 months (range 16–186), the 5-year PFS and OS were 39% (95% CI 27–52) and 60% (95% CI 55–77), respectively. On multivariate analysis: age >55 years was associated with both a reduced PFS (RR 2.11, 95% CI 1.15–3.87) and OS (RR 5.53, 95% CI 2.22–13.76); chemorefractory disease at allo-HCT was associated with both reduced PFS (RR 3.09, 95% CI 1.37–7.00) and OS (RR 3.19, 95% CI 1.23–8.22). At relapse, 24 patients (56%) received bortezomib, 28 (65%) lenalidomide, 11 (26%) pomalidomide, 16 (37%) donor lymphocytes infusion as part of salvage therapy after allo-HCT relapse. Median PFS from time of salvage treatment was 7 months (range 0–113 months) for bortezomib-based therapy, 14 months (range 0–79 months) for lenalidomide and 10 months (range 1–28) for pomalidomide. Allo-HCT is a feasible and effective strategy in selected patients with MM and could be an effective platform for subsequent therapies.

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Acknowledgements

We gratefully acknowledge all patients and their families. Daniela Majerna and Anna Maria De Filippo helped in revising the manuscript. The study was supported by Associazione Italiana per la Ricerca sul Cancro (AIRC) and Associazione Italiana contro le Leucemie-Linfomi e Mieloma ONLUS (AIL).

Author contributions

Conception and design: PC, VM and AM; collection and assembly of data: AM, FR, MC, CdP, MP and FM; data analysis: AM and VM; interpretation: VM, AM and PC; manuscript writing: first draft prepared by VM and AM. All authors helped revising the manuscript. Final approval of manuscript was done by all authors.

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Authors and Affiliations

  1. Dipartimento di Ematologia e Onco-Ematologia Pediatrica, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    V Montefusco, A Mussetti, F Rezzonico, F Maura, M Pennisi, C de Philippis, M Capecchi & P Corradini

  2. Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milan, Italy

    F Maura, M Pennisi, C de Philippis, M Capecchi & P Corradini

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  1. V Montefusco
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Correspondence to A Mussetti.

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Montefusco, V., Mussetti, A., Rezzonico, F. et al. Allogeneic stem cell transplantation and subsequent treatments as a comprehensive strategy for long-term survival of multiple myeloma patients. Bone Marrow Transplant 52, 1602–1608 (2017). https://doi.org/10.1038/bmt.2017.183

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