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Monocyte recovery at day 100 is associated with improved survival in multiple myeloma patients who undergo allogeneic hematopoietic cell transplantation

Bone Marrow Transplantation volume 51, pages 297–299 (2016)Cite this article

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High-dose chemotherapy with autologous hematopoietic cell transplantation (AutoHCT) has demonstrated both improvement in event-free survival and overall survival (OS) in patients with multiple myeloma (MM).1 Despite improved outcomes with novel therapies and AutoHCT, neither strategy provides prolonged disease control in MM. Only allogeneic HCT (AlloHCT), in part due to a graft versus myeloma effect, can provide a potentially curative option.2 However, the use of AlloHCT has been limited by its toxicity and treatment-related mortality. Historically, AlloHCT was used in patients with aggressive myeloablative conditioning regimens with treatment-related mortality between 15% and 40%.3 In more recent years, improvements in supportive care and new conditioning regimens have improved these numbers.4 Rapid immune reconstitution as evidenced by lymphocyte and monocyte recovery has been associated with improved survival in patients after AlloHCT in hematological malignancies, such as acute leukemia.5 In this study, we sought to find out whether lymphocyte and monocyte recovery are similarly associated with OS in patients undergoing AlloHCT in MM.

We performed an Institutional Review Board-approved retrospective analysis of consecutive patients who underwent AlloHCT for MM between 2002 and 2013 at a tertiary medical center. Patients received either a myeloablative or non-myeloablative conditioning regimen. The non-myeloablative regimen consisted of low dose TBI either alone or with other drugs, fludarabine (Flu) with cyclophosphamide (CyFlu) or TBI with fludarabine (FluTBI) or combination of melphalan with fludarabine (FluMel). Cyclophosphamide with TBI (CyTBI) was the myeloablative conditioning regimen used. All patients underwent prior AutoHCT except for one who had an upfront AlloHCT. GVHD prophylaxis consisted of methotrexate and tacrolimus. Patient received antimicrobial prophylaxis with ciprofloxacin, acyclovir, fluconazole/voriconzaole and trimethoprim-sulfamethaxozole/dapsone.

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Acknowledgements

This project was supported by the National Center for Research Resources, The National Center for Advancing Translational Sciences and the Office of the Director, National Institutes of Health through 8UL1TR000055. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. Dr D’Souza is supported by Institutional Research Grant no. 86-004-26 from the American Cancer Society.

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  1. Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    B Dhakal, C A Lara, P Hari, M Pasquini & A D’Souza

  2. Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA

    R Brazauskas

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  1. B Dhakal
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Correspondence to A D’Souza.

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Dhakal, B., Brazauskas, R., Lara, C. et al. Monocyte recovery at day 100 is associated with improved survival in multiple myeloma patients who undergo allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 51, 297–299 (2016). https://doi.org/10.1038/bmt.2015.244

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