Allo-SCT for multiple myeloma: a review of outcomes at a single transplant center

Abstract

Allogeneic stem cell transplant for multiple myeloma (MM) is one treatment associated with long term disease free survival. The high incidence of treatment related mortality and relapses, however, are important reasons for controversy about the role of allografting in the management of MM. We reviewed our results of allografting for MM spanning a period of 34 years in order to better define long term outcomes and identify areas of progress as well as areas needing improvement. A total of 278 patients received allogeneic marrow or peripheral blood stem cells after high dose myeloablative (N=144) or reduced intensity, non-myeloablative (N=134) regimens. In multivariable analysis, adjusting for differences in patient groups, reduced intensity/nonmyeloablative transplants were associated with significantly less acute GVHD, lower transplant mortality, better progression free survival and overall survival. There were no significant differences in relapse, progression or chronic GVHD, when adjusted. In multivariable analysis of patients receiving only non-myeloablative transplants, decreased overall survival and progression free survival were associated with relapse after a prior autograft and a β2 microglobulin >4.0. Transplant mortality was reduced and only influenced by a prior tandem autograft.

Allogeneic hematopoietic SCT in multiple myeloma: long-term results from a single institution

“…For patients undergoing nonmyeloablative allografts, the PFS and OS at 10 years were 16% and 39%, respectively. As in the Seatle and the EBMT series, 19,24 we found a higher cumulative TRM and a lower relapse rate in the allo-MAC group compared with the allo-RIC.…”

“…Bensinger et al 24 reported the long-term outcome of the Seatle experience in allogeneic transplantation in MM. In this series, the nonrelapse mortality at 2 years was 55% and 18% with allo-MAC and allo-RIC, respectively.…”

“…21,22 It is of note that in the series with longest follow-up, including up-front and relapsed patients, the PFS is about 25% at 5 years and between 16 and 24% at 10 years and the OS about 55% at 5 years and from 30 to 40% at 10 years. 23,24 It is important to consider that this high-risk procedure is usually only offered to patients with the poorest short-term predicted outcome with conventional therapies. As a matter of fact, the number of patients undergoing allo-HCT for MM in institutions with a high-transplant activity is low and the published results usually come from registry studies rather than single institution series.…”

A transplant “immunome” screening platform defines a targetable epitope fingerprint of multiple myeloma

“…2 Myeloma is currently considered incurable for the majority of patients, with allogeneic hematopoietic stem cell transplantation (HSCT) being to date the only treatment modality that reports long-term remissions in a small subset of patients. [3][4][5][6][7][8] However, the majority of myeloma patients are ineligible for this radical form of immunotherapy due to age or medical restrictions. Passive immunotherapy with monoclonal antibodies targeting myeloma cell surface molecules has been preclinically developed over the past decade for some targets such as CD38 or SLAM-F7.…”

Multiple Myeloma: New Perspectives

“…Allogeneic stem cell transplantation means transplantation of a healthy person's stem cells into the affected patient which may have the potential for cure, but is used in a very low percentage of patients. Also, this line of treatment may have a 5-10% treatment-associated mortality rate which makes it not a constituent of the initial therapy [30].…”