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Autologous or reduced-intensity conditioning allotransplantation for de novo multiple myeloma

Bone Marrow Transplantation volume 43, pages 591–592 (2009)Cite this article

Recent pilot studies combining a cytoreductive autologous SCT (auto-SCT) with a reduced-intensity conditioning regimen (RIC) allograft have reported encouraging results in patients with de novo multiple myeloma up to the age of 65 years, with achievement of high CR rates and TRM rate inferior to 15%.1, 2 These results justified prospective trials comparing this auto/RIC allo-SCT tandem approach with double auto-SCT, which previously had been shown to be superior to single auto-SCT.3 Until now, only three prospective studies comparing the combination of auto-SCT followed by RIC allograft with tandem auto-SCT have been reported, one from the Intergroupe Francophone du Myélome,4, 5 one from Italy6 and one from Spain.7

The results differ significantly, which partly may be explained through the study design. Inclusion criteria, conditioning regimens and feasibility of the procedures were different. The French trial focused on patients with high-risk disease, defined by both elevated β2-microglobuline and chromosome 13 deletion at diagnosis,8 whereas the Italian group included all patients irrespective of the prognostic factors. The Spanish group restricted the genetic randomization to chemosensitive patients failing to achieve CR or near-CR following a first auto-SCT. All patients received a first auto-SCT prepared by melphalan 200 mg/m2 (mel 200) in the French trial, whereas the doses of melphalan varied from 100 to 200 mg/m2 in the Italian trial, and the Spanish group used either mel 200 or 12 Gy TBI plus mel 140. Moreover, in the latter trial, the second auto-SCT was prepared either by mel 200 or CVB. In the allogeneic arm, high-dose ATG was used in the French trial, low-dose TBI only in the Italian study, and a more dose-intensive regimen, combining mel 140 with fludarabin, was infused in the Spanish group. The tandem auto-SCT was completed in 56% of the patients in the Italian trial as compared with 76% in the French trial, whereas the feasibility of the planned auto-SCT/RIC-allo was identical in these two trials (72 and 71%, respectively).

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References

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  1. Hematology Department, University Hospital, Place Alexis Ricordeau, Nantes cedex, France. E-mail: philippe.moreau@chu-nantes.fr,

    P Moreau

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Moreau, P. Autologous or reduced-intensity conditioning allotransplantation for de novo multiple myeloma. Bone Marrow Transplant 43, 591–592 (2009). https://doi.org/10.1038/bmt.2008.365

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