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High-dose chemotherapy with autologous stem cell rescue for relapse after allo-SCT in multiple myeloma

Bone Marrow Transplantation volume 46, pages 1156–1157 (2011)Cite this article

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High-dose chemotherapy followed by autologous stem cell rescue is proven to prolong disease-free and OS in eligible patients with multiple myeloma and has therefore been part of the standard care for patients younger than 65 years of age.1 On the other hand, the role of allo-SCT is yet to be established; although it can induce molecular remission, treatment-related morbidity and mortality are high especially with myeloablative regimens.2 Allo-SCTs with non-myeloablative regimens have been offered in clinical trials to selected younger patients including those with high-risk disease features such as deletion of chromosome 13 and high β-2 microglobulin levels.3

We report a 48-year-old African-American woman who initially presented in June 1999 with right shoulder pain and a pathologic humeral fracture, which was proven to be a plasmacytoma on biopsy. She was treated with internal fixation and 10 fractions of local radiotherapy. BM biopsy showed 50% involvement with plasma cells that had κ-light chain restriction and a normal karyotype. Serum Igs, serum and urine protein electrophoresis with immunofixation were within normal limits. Skeletal survey revealed multiple lytic lesions involving the right humerus, right scapula, sternum, ribs, spine and pelvis. She received two cycles of VAD (vincristine, adriamycin and dexamethasone) followed by CY mobilization, a fludarabine and melphalan-based conditioning regimen and HLA-matched allo-SCT from her sister in October 1999. BM biopsy 100 days after the transplant showed CR with 5% plasmacytosis and 100% donor chimerism. She did not develop significant GVHD, despite non-compliance with the immunosuppressive regimen, which was stopped approximately 3 months after the transplant. She has been followed with regular clinic visits and yearly BM biopsies thereafter. She remained in good health with no evidence of relapse until January 2008 when the BM biopsy showed 30% plasmacytosis with κ-light chain restriction. She was also found to have new-onset renal insufficiency with a 50 mL/min estimated glomerular filtration rate and a serum creatinine of 1.4 mg per 100 mL. The skeletal survey was unchanged; serum and urine paraprotein studies were still within normal limits. Peripheral blood molecular studies with STR engraftment analysis showed 100% donor chimerism. She received four cycles of lenalidomide and dexamethasone. A repeat BM biopsy showed reactive plasmacytosis and normal cytogenetics. She then underwent stem cell mobilization with 10 μcg/kg/day of G-CSF, and 4.63 × 106 CD34+ cells/kg were collected over 3 days. This was followed by conditioning with a melphalan-based regimen and autologous stem cell infusion in July 2008. The hospital course was uncomplicated with engraftment on day 11.

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References

  1. Child JA, Morgan GJ, Davies FE, Owen RG, Bell SE, Hawkins K et al. High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med 2003; 348: 1875–1883.

    Article  CAS  Google Scholar 

  2. Shaw BE, Peggs K, Bird JM, Cavenagh J, Hunter A, Madrigal JA et al. The outcome of unrelated donor stem cell transplantation for patients with multiple myeloma. Br J Haematol 2003; 123: 886–895.

    Article  PubMed  Google Scholar 

  3. Gerull S, Goerner M, Benner A, Hegenbart U, Klein U, Schaefer H et al. Long-term outcome of nonmyeloablative allogeneic transplantation in patients with high-risk multiple myeloma. Bone Marrow Transplant 2005; 36: 963–969.

    Article  CAS  PubMed  Google Scholar 

  4. Bruno B, Rotta M, Patriarca F, Mordini N, Allione B, Carnevale-Schianca F et al. A comparison of allografting with autografting for newly diagnosed multiple myeloma. N Engl J Med 2007; 356: 1110–1120.

    Article  CAS  PubMed  Google Scholar 

  5. Lokhorst HM, Wu K, Verdonck LF, Laterveer LL, van de Donk NW, van Oers MH et al. The occurrence of graft-versus-host disease is the major predictive factor for response to donor lymphocyte infusions in multiple myeloma. Blood 2004; 103: 4362.

    Article  CAS  Google Scholar 

  6. van de Donk NW, Kroger N, Hegenbart U, Corradini P, San Miguel JF, Goldschmidt H et al. Prognostic factors for donor lymphocyte infusions following non-myeloablative allogeneic stem cell transplantation. Bone Marrow Transplant 2006; 37: 1135–1141.

    Article  CAS  PubMed  Google Scholar 

  7. Bellucci R, Wu CJ, Chiaretti S, Weller E, Davies FE, Alyea EP et al. Complete response to donor lymphocyte infusion in multiple myeloma is associated with antibody responses to highly expressed antigens. Blood 2004; 103: 656–663.

    Article  CAS  PubMed  Google Scholar 

  8. van de Donk NW, Kroger N, Hegenbart U, Corradini P, San Miguel JF, Goldschmidt H et al. Remarkable activity of novel agents bortezomib and thalidomide in patients not responding to donor lymphocyte infusions following nonmyeloablative allogeneic stem cell transplantation. Blood 2006; 107: 3415–3416.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Blood and Marrow Transplantation, Roger Williams Medical Center, Providence, IL, USA

    H H Tuncer

  2. Sections of Hematology and Stem Cell Transplantation, Rush University Medical Center, Chicago, IL, USA

    S A Gregory & H C Fung

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  1. H H Tuncer
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  2. S A Gregory
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  3. H C Fung
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Correspondence to H H Tuncer.

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Tuncer, H., Gregory, S. & Fung, H. High-dose chemotherapy with autologous stem cell rescue for relapse after allo-SCT in multiple myeloma. Bone Marrow Transplant 46, 1156–1157 (2011). https://doi.org/10.1038/bmt.2010.251

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