Work

Improved Outcome for Allogeneic Transplantation Performed After January 2000

Year: 2009

Type: article

Abstract: Background: Allogeneic hematopoietic stem cell transplantation (allo SCT) is a potentially curative approach in patients with multiple myeloma (MM). The potential benefit is offset by a higher risk of transplant-related mortality (TRM), graft-vs-host disease (GVHD) and opportunistic infections. A number of factors including better supportive care, antimicrobial agents, improvement in HLA typing and reduced intensity conditioning (RIC) regimens have resulted in a lower risk of TRM. We evaluated if there was an improvement in the outcome of patients who received allo SCT for MM after January 1, 2000 compared to patients who received allo SCT before that date. Methods: 101 patients underwent allo SCT at UT-MDACC between 11/1985 and 1/2007, with 40 patients undergoing allo SCT before January 1, 2000 (group A) and 61 after that date (group B). Median age at allo SCT in Group A and B was 42 and 48 years, respectively; median number of prior regimens in both groups was 5. Twelve patients (30%) in group A and 42 patients (69%) in group B had a prior autologous SCT. Results: Median follow up in surviving patients was 8.2 years in group A and 2 years in group B. Reduced-intensity conditioning (RIC) regimens were used in 15 patients (37%) in group A, and 56 patients (92%) in group B. Cumulative TRM in group A and B was 57% and 31%, respectively (p = 0.006). Disease progression was seen in 15 patients (37.5%) in group A and in 31 patients (50%) in group B (p = 0.22). Time to progression from allo SCT was 10.1 moths, with no significant difference between the 2 groups (p = 0.85). As shown in Figures 1 and 2, patients in group B had significantly longer PFS (7.3 vs. 4.8 months; p = 0.03, log rank test) and OS (13.1 Months vs. 5.9 months; p = 0.008, log rank test). Grade II-IV acute GVHD was seen in 21 patients (52%) in group A, and 21 patients (34%) in group B (p = 0.09). Limited or extensive chronic GVHD was seen in 15 patients (37%) in group A, and 20 patients (32%) in group B (p = 0.67). At the time of this analysis, 3 patients in group A and 18 in group B were alive, while 2 patients in group A and 12 in group B were alive and in remission. Conclusions: Patients transplanted after January 2000 although older and having failed a prior ASCT had significantly lower TRM, lower incidence of acute GVHD and significantly longer PFS and OS.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2008.12.212