1. ¹Unité de Transplantation et de Thérapie Cellulaire (UTTC), Institut Paoli-Calmettes, Marseille, France
2. ²Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
3. ³Département d'Hématologie, Institut Paoli-Calmettes, Marseille, France
4. ⁴CHU Edouard Herriot, Lyon, France
5. ⁵Centre Jean-Perrin, Clermont-Ferrand, Marseille, France
6. ⁶Université de la Méditerranée, Marseille, France

Correspondence: Dr M Mohty, Unité de Transplantation et de Thérapie Cellulaire (UTTC), Institut Paoli-Calmettes and Université de la Méditerranée, 232 Bd. Ste Marguerite, 13273 Marseille Cedex 09, France. E-mail: mohtym@marseille.fnclcc.fr

Received 30 November 2003; Accepted 3 February 2004; Published online 10 May 2004.

Abstract

In all, 41 multiple myeloma (MM) patients received an antithymocyte globulin (ATG), fludarabine, and busulfan-based reduced intensity conditioning (RIC) for allogeneic stem cell transplantation (allo-SCT) from HLA-identical siblings. In total, 29 patients (70%) were in partial remission, one patient in complete remission, and 11 (27%) with progressive disease at the time of allo-SCT. Median time between diagnosis and allo-SCT was 24 months. The cumulative incidences of grade II–IV and grade III–IV acute graft-versus-host disease (GVHD) were 36% (95% CI, 21–51%) and 7% (95% CI, 2–20%), respectively. Overall, 10 patients developed limited chronic GVHD, whereas seven developed an extensive form (cumulative incidence, 41% (95% CI, 26–56%) at 2 years). With a median follow-up of 389 days, the overall cumulative incidence of transplant-related mortality (TRM) was 17% (95% CI, 6–28%). In all, 11 patients (27%) are in continuous complete remission, and the Kaplan–Meier estimates of overall survival (OS) and progression-free survival (PFS) at 2 years were 62% (95% CI, 47–76%) and 41% (95% CI, 23–62%), respectively. PFS and OS were significantly higher in patients with chronic GVHD as compared to patients without chronic GVHD (P=0.006 for PFS and P=0.01 for OS). Collectively, these data demonstrate that RIC allo-SCT can mediate a potentially curative graft-versus-myeloma effect with an acceptable incidence of toxicity and TRM.