Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Myeloma

Outcome after autologous and allogeneic stem cell transplantation for patients with multiple myeloma: impact of graft-versus-myeloma effect

Summary:

A total of 228 patients with multiple myeloma (MM), 166 patients receiving autologous transplantation (124 PBSC and 38 BM) and 66 patients receiving T-cell-depleted allogeneic transplantation were analyzed to compare overall survival (OS), progression-free survival (PFS) and risk of relapse. Patients receiving autologous transplantation had a significantly improved OS (P=0.006) and PFS (P=0.002) at 2 years with OS and PFS for autologous transplant 74% and 48%, respectively, compared with 51% and 28% for allogeneic transplantation. By 4 years after transplantation, outcome was similar with OS and PFS for autologous transplantation 41% and 23%, respectively, compared with 39% and 18% for allogeneic transplantation. The 4-year cumulative incidence of nonrelapse mortality was significantly higher in patients receiving allogeneic transplantation (24% vs 13%) (P=0.004). Relapse was the principle cause of treatment failure for both groups; however, there was a significantly reduced risk of relapse associated with allogeneic transplantation at 4 years: 46% for allograft vs 56% for autograft (P=0.02). Despite a lower risk of relapse after allogeneic transplantation, autologous transplantation is associated with improved OS and PFS compared with allogeneic transplantation in patients with MM. Strategies focused on reducing nonrelapse mortality in allogeneic transplantation may translate into an improved outcome for patients receiving allogeneic transplantation.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Attal M, Harousseau JL, Stoppa AM et al. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Francais du Myelome (see comments). N Engl J Med 1996; 335: 91–97.

    Article  CAS  PubMed  Google Scholar 

  2. Bensinger WI, Buckner CD, Anasetti C et al. Allogeneic marrow transplantation for multiple myeloma: an analysis of risk factors on outcome. Blood 1996; 88: 2787–2793.

    CAS  PubMed  Google Scholar 

  3. Gahrton G, Tura S, Ljungman P et al. Allogeneic bone marrow transplantation in multiple myeloma. N Engl J Med 1991; 325: 1267–1273.

    Article  CAS  PubMed  Google Scholar 

  4. Gahrton G, Tura S, Ljungman P et al. Prognostic factors in allogeneic bone marrow transplantation for multiple myeloma (see comments). J Clin Oncol 1995; 13: 1312–1322.

    Article  CAS  PubMed  Google Scholar 

  5. Bjorkstrand B, Ljungman P, Svensson H et al. Allogeneic bone marrow transplantation versus autologous stem cell transplantation in multiple myeloma: a retrospective case-matched study from the European Group for Blood and Marrow Transplantation. Blood 1996; 88: 4711–4718.

    CAS  PubMed  Google Scholar 

  6. Anderson K, Andersen J, Soiffer R et al. Monoclonal antibody-purged bone marrow transplantation therapy for multiple myeloma. Blood 1993; 82: 2568–2576.

    CAS  PubMed  Google Scholar 

  7. Schlossman RL, Anderson KC . Bone marrow transplantation in multiple myeloma. Curr Opin Oncol 1000; 11: 102–108.

    Article  Google Scholar 

  8. Rohatiner A, Gelber R, Schlossman SF et al. Depletion of T cells from human bone marrow using monoclonal antibodies and rabbit complement. A quantitative and functional analysis. Transplantation 1986; 42: 73–80.

    Article  CAS  PubMed  Google Scholar 

  9. Alyea EP, Soiffer RJ, Canning C et al. Toxicity and efficacy of defined doses of CD4(+) donor lymphocytes for treatment of relapse after allogeneic bone marrow transplant. Blood 1998; 91: 3671–3680.

    CAS  PubMed  Google Scholar 

  10. Rosner B . Fundamentals of Biostatistics, 3rd edn. PWS-Kent: Boston, 1990.

    Google Scholar 

  11. Kaplan G, Meier P . Non-parametric estimation from incomplete observations. J Am Statist Assoc 1958; 53: 457–481.

    Article  Google Scholar 

  12. Sehn LH, Alyea EP, Weller E et al. Comparative outcomes of T-cell-depleted and non-T-cell-depleted allogeneic bone marrow transplantation for chronic myelogenous leukemia: impact of donor lymphocyte infusion. J Clin Oncol 1999; 17: 561–568.

    Article  CAS  PubMed  Google Scholar 

  13. Gray R . A class of k-sample tests for comparing the cumulative incidence of a competing risk. Ann Statist 1988; 16: 1141–1154.

    Article  Google Scholar 

  14. Reynolds C, Ratanatharathorn V, Adams P et al. Allogeneic stem cell transplantation reduces disease progression compared to autologous transplantation in patients with multiple myeloma. Bone Marrow Transplant 2001; 27: 801–807.

    Article  CAS  PubMed  Google Scholar 

  15. Couban S, Stewart AK, Loach D et al. Autologous and allogeneic transplantation for multiple myeloma at a single centre. Bone Marrow Transplant 1997; 19: 783–789.

    Article  CAS  PubMed  Google Scholar 

  16. Mehta J, Tricot G, Jagannath S et al. Salvage autologous or allogeneic transplantation for multiple myeloma refractory to or relapsing after a first-line autograft? Bone Marrow Transplant 1998; 21: 887–892.

    Article  CAS  PubMed  Google Scholar 

  17. Lokhorst HM, Schattenberg A, Cornelissen JJ et al. Donor leukocyte infusions are effective in relapsed multiple myeloma after allogeneic bone marrow transplantation. Blood 1997; 90: 4206–4211.

    CAS  PubMed  Google Scholar 

  18. Salama M, Nevill T, Marcellus D et al. Donor leukocyte infusions for multiple myeloma. Bone Marrow Transplant 2000; 26: 1179–1184.

    Article  CAS  PubMed  Google Scholar 

  19. Alyea E, Weller E, Schlossman R et al. T-cell-depleted allogeneic bone marrow transplantation followed by donor lymphocyte infusion in patients with multiple myeloma: induction of graft-versus-myeloma effect. Blood 2001; 98: 934–939.

    Article  CAS  PubMed  Google Scholar 

  20. Giralt S, Weber D, Cohen A et al. Non Myeloablative Conditioning with Fludarabine and Melphalan for Patients with Multiple Myeloma, ASBMT. Keystone, CO, 1999, pp 43.

    Google Scholar 

  21. Badros A, Barlogie B, Siegel E et al. Improved outcome of allogeneic transplantation in high-risk multiple myeloma patients after nonmyeloablative conditioning. J Clin Oncol 2002; 20: 1295–1303.

    Article  PubMed  Google Scholar 

  22. Garban F, Attal M, Rossi JF et al. Immunotherapy by non-myeloablative allogeneic stem cell transplantation in multiple myeloma: results of a pilot study as salvage therapy after autologous transplantation. Leukemia 2001; 15: 642–646.

    Article  CAS  PubMed  Google Scholar 

  23. Michallet M, Bilger K, Garban F et al. Allogeneic hematopoietic stem-cell transplantation after nonmyeloablative preparative regimens: impact of pretransplantation and posttransplantation factors on outcome. J Clin Oncol 2001; 19: 3340–3349.

    Article  CAS  PubMed  Google Scholar 

  24. Kroger N, Schwerdfeger R, Kiehl M et al. Autologous stem cell transplantation followed by a dose-reduced allograft induces high complete remission rate in mutiple myeloma. Blood 2002; 100: 755–760.

    Article  CAS  PubMed  Google Scholar 

  25. Barlogie B, Jagannath S, Vesole DH et al. Superiority of tandem autologous transplantation over standard therapy for previously untreated multiple myeloma. Blood 1997; 89: 789–793.

    CAS  PubMed  Google Scholar 

  26. Barlogie B, Jagannath S, Desikan KR et al. Total therapy with tandem transplants for newly diagnosed multiple myeloma. Blood 1999; 93: 55–65.

    CAS  PubMed  Google Scholar 

  27. Stewart AK, Vescio R, Schiller G et al. Purging of autologous peripheral-blood stem cells using CD34 selection does not improve overall or progression-free survival after high-dose chemotherapy for multiple myeloma: results of a multicenter randomized controlled trial. J Clin Oncol 2001; 19: 3771–3779.

    Article  CAS  PubMed  Google Scholar 

  28. Vescio R, Schiller G, Stewart AK et al. Multicenter phase III trial to evaluate CD34(+) selected versus unselected autologous peripheral blood progenitor cell transplantation in multiple myeloma. Blood 1999; 93: 1858–1868.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We acknowledge the dedication of the staff of the Connell-O'Reilly Cell Manipulation Laboratory, which processed all the cell products in this study. This study is supported by Grant CA 78378 from the National Institutes of Health and the Doris Duke Distinguished Clinical Research Scientist Award.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to E Alyea.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Alyea, E., Weller, E., Schlossman, R. et al. Outcome after autologous and allogeneic stem cell transplantation for patients with multiple myeloma: impact of graft-versus-myeloma effect. Bone Marrow Transplant 32, 1145–1151 (2003). https://doi.org/10.1038/sj.bmt.1704289

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1704289

Keywords

This article is cited by

Search

Quick links