Predictors of prolonged survival after allogeneic hematopoietic stem cell transplantation for multiple myeloma |
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Authors: | Bashir Qaiser Khan Hassan Orlowski Robert Z Amjad Ali Imran Shah Nina Parmar Simrit Wei Wei Rondon Gabriela Weber Donna M Wang Michael Thomas Sheeba K Shah Jatin J Qureshi Sofia R Dinh Yvonne T Popat Uday Anderlini Paolo Hosing Chitra Giralt Sergio Champlin Richard E Qazilbash Muzaffar H |
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Institution: | Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030-4009, USA. qbashir@mdanderson.org |
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Abstract: | A total of 149 patients with multiple myeloma (MM) who received allogeneic hematopoietic stem cell transplantation (allo-HCT) with myeloablative (MAC; n = 38) or reduced-intensity conditioning (RIC; n = 110) regimens at MD Anderson Cancer Center were evaluated. Of the total, 120 (81%) patients had relapsed or had refractory disease. Median age of MM patients was 50 (28-70) years with a followup time of 28.5 (3-164) months. The 100-day and 5-year treatment related mortality (TRM) rates were 17% and 47%, respectively. TRM was significantly lower with RIC regimens (13%) vs. 29% for MAC at 100 days (P = 0.012). The cumulative incidence of Grade II-IV acute graft-versus-host disease (GVHD) was 35% and chronic GVHD was 46%. PFS and OS at 5 years were 15% and 21%, respectively. In multivariate analysis, allo-HCT for primary remission consolidation was associated with longer PFS (HR 0.35; 95% CI, 0.18-0.67) and OS (HR 0.29; 95% CI 0.15-0.55), while absence of high-risk cytogenetics was associated with longer PFS only (HR 0.59; 95% CI 0.37-0.95). We observe that TRM has decreased with the use of RIC regimens, and long-term disease control can be expected in a subset of MM patients undergoing allo-HCT. Further studies should be conducted in carefully designed clinical trials in this patient population. |
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