Prognostic factors in allogeneic bone marrow transplantation for multiple myeloma.

Abstract

Purpose: To analyze prognostic factors for allogeneic bone marrow transplantation (BMT) in multiple my eloma.Patients and Methods: One hundred sixty-two reports of allogeneic matched sibling-donor transplants in multiple myeloma received by the European Group for Blood and Marrow Transplantation (EBMT) registry be tween 1983 and early 1993 were analyzed for prognos tic factors. End points were complete remission, survival, and duration of complete remission.Results: Following BMT, 44% of all patients and 60% of assessable patients entered complete remission. The overall actuarial survival rate was 32% at 4 years and 28% at 7 years. The overall relapse-free survival rate of 72 patients who were in complete remission after BMT was 34% at 6 years. Favorable pretransplant prognostic factors for survival were female sex (41% at 4 years), stage I disease at diagnosis (52% at 4 years), one line of previous treatment (42% at 4 years), and being in complete remission before conditioning (64% at 3 years). The subtype immunoglobulin A (IgA) myeloma and a low /?2~rnicroglobulin level (< 4 g/L) also tended to have a favorable prognostic impact. The most important post transplant prognostic factor was to enter a complete re mission. Grade III to IV graft-versus-host disease (GVHD) was associated with poor survival. M ULTIPLE MYELOMA is a malignant disorderwith a median survival duration of less than 3 years after conventional chemotherapy.1-3 However, sur vival is highly variable. Some patients die within months, while occasional patients survive more than 10 years. This heterogeneity in the prognosis of multiple myeloma has encouraged studies of prognostic variables. A high tumor burden, high C~reactive protein level, high plasma cell thymidine-labeling index, elevated /^-microglobulin level, low serum albumin level, and low platelet count have been associated with extremely poor survival fol lowing conventional chemotherapy.4'8 Therefore, such variables have been used to select patients for more inten sive treatment. However, only a few studies have at tempted to delineate prognostic factors of importance for the outcome of patients treated with high-dose chemo therapy followed by either autologous bone marrow trans plantation (ABMT)9,10 or allogeneic bone marrow trans-

Allogeneic stem cell transplantation for multiple myeloma: is there a future?

“…These early data can be extracted from the transplant registries: the European Bone Marrow Transplantation (EBMT), International Bone Marrow Transplantation Registry and the Fred Hutchinson Cancer Center registry. [13][14][15] A most consistent finding with the use of myeloablative conditioning was high TRM of 40-60% (Table 1). Early TRM in the EBMT report was~45%, 14,15 with deaths mainly due to infection, GVHD and regimen-related toxicities.…”

“…[13][14][15] A most consistent finding with the use of myeloablative conditioning was high TRM of 40-60% (Table 1). Early TRM in the EBMT report was~45%, 14,15 with deaths mainly due to infection, GVHD and regimen-related toxicities. In a subsequent study, EBMT compared the patients who received transplants between 1983 and 1993 with those who received transplants between 1994 and 1998, showing a decrease in TRM from 46 to 30% at 2 years with better patient selection earlier in the disease course with chemotherapy-sensitive disease.…”

Relevance of age on survival of 341 patients with multiple myeloma treated with conventional chemotherapy: updated results of the MM87 prospective randomized protocol

“…Median survival was 44 months in our series and 28-41 months in autologous BMT series (Jagannath et al, 1993;Bjorkstrand et al, 1994;Besinger et al, 1996;Vesole et al, 1996). In the only published series in which patients aged less than 55 years were treated with allogeneic BMT (Gahrton et al, 1995), median survival was 17 months and 4-year survival was 34%. The corresponding figures for our < 55 years patients are 57 months and 46% (Figure 4).…”

Outcome assessment of a population-based group of 195 unselected myeloma patients under 70 years of age offered intensive treatment

“…Results from the EBMT registry, 26 as well as those from that no patient has required the use of melphalan alone, without rescue, since the introduction of peripheral blood Cavo's group, 27,28 suggest that patients with responsive disease as well as those with less prior treatment have a better stem cell rescue.…”