HCT has been shown to improve survival in patients with MM, however the role allogeneic HCT remains controversial. We report on consecutive patients who underwent autologous (n=63) or allogeneic (n=16) HCT for MM at our Institution. Median age of patients at transplant was 56 (range, 36-69) years for autologous, and 45 (range, 34-57) years for allogeneic HCT. The majority of patients had stage II (30% autologous; 38% allogeneic) or stage III (65% auto; 62% allo) MM at diagnosis. Median time from diagnosis to HCT was 9.5 months (allo) and 8.5 months (auto). More patients with MM refractory to conventional dose chemotherapy received allogeneic HCT (56% vs 25%; p=0.02). The conditioning regimens included busulfan and cyclophosphamide (allo, n=8; auto, n=7), busulfan, cyclophosphamide and VP16 (allo, n=7; auto, n=53), or high-dose melphaJan with or without TBI (allo, n=l ; auto, n=3). The median follow-up was 10.5 (0.6-61) months for autologous, and 24.1 ( 1.3-110.9) months for allogeneic patients. Toxicity was higher in patients who received allogeneic HCT. Eleven of 16 patients who received allogeneic HCT have died, 6 due to disease relapse and 5 (31%) due to treatment-related causes (fungal infection, n=3; ARDS, n=l; bacterial sepsis, n=l). Acute graft-versus-host (GVH) disease occurred in 10 patients and was predominantly grade HI (n=7). In contrast, 23 of 63 patients who received autologous HCT have died, mostly from relapsed disease, and only 3 (5%) from transplant-related causes. Overall survival (OS) was not significantly different for the two groups. The median OS was 30.9 months with a 5-year survival of 23% for autologous, compared to a median of 17.1 months and a 5-year survival of 33% for allogeneic HCT patients (p=0.20). The estimated probability of relapse at 5 years was 78% for allogeneic, compared to 100% for autologous HCT patients (p=0.68). Although this did not reach statistical significance, it is notable that only 2 patients remain alive and free of disease beyond 5 years; both of these patients received allogeneic transplants for refractory MM and are alive at 8.4 and 9.2 years. Only one of these patients developed GVH disease (grade I). We conclude that although allogeneic HCT in MM is associated with greater toxicity and mortality, and similar overall survival compared to autologous HCT, it remains the only potentially curative therapy. For patients prepared to take the risk of a higher treatmentrelated mortality, allogeneic HCT may still be offered as the preferred therapy where a donor is available, particularly for those whose disease is refractory to conventional dose chemotherapy.
|Original language||English (US)|
|Issue number||11 PART II|
|State||Published - Dec 1 2000|
ASJC Scopus subject areas
- Cell Biology