Work

Risk-factors of melphalan/fludarabine dose-reduced allogeneic stem cell transplantation in patients with multiple myeloma

Year: 2004

Type: article

Abstract: To evaluate the impact of timing of dose-reduced allograft in patients with multiple myeloma, we analyzed 120 patients in a retrospective study, who were treated with melphalan/fludarabine as conditioning regimen. The cumulative risk at one year for treatment-related mortality (TRM) was 18% (95% CI: 12–28%). In a multivariate analysis, relapse after prior high-dose chemotherapy was the most significant factor for TRM (HR 2.80; 95% CI: 1.16–6.74; p = 0.02), relapse (HR 4.14; 95% CI: 2.04–8.38, p < 0.001), event-free (HR 3.11; 95% CI: 1.77–5.46; p < 0.001), and overall survival (HR 2.69; 95% CI: 1.35–5.35; p = 0.005). In addition, relapse was also significantly diminished by chronic GvHD in a time-dependent Cox model (HR 0.37; 95% CI: 0.16–0.87; p = 0.02), while trans-plantation with peripheral blood stem cells (PBSC) resulted in better overall survival (HR 0.35; 95% CI: 0.14–0.88; p = 0.002). In a subgroup of patients with chemosensitivity at time of transplantation and no relapse after a prior high-dose chemotherapy who were transplanted with PBSC (n = 46), the cumulative risk of TRM at one year was only 8% (95% CI: 1–54%), and the two-year estimated event-free and overall survival was 60% (95% CI: 42–78%) and 75% (95% CI: 59–91%) for related (n = 34), and 81% (95% CI: 59–100%) and 92% (95% CI: 76–100%) for unrelated donors (n = 12). We conclude that dose-reduced allograft with related and unrelated donors should be performed at an earlier stage of the disease in patients who are chemosensitive and without relapse after a prior autograft, resulting in a lower TRM and better event-free and overall survival.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2003.12.098