In Pursuit of the Graft Versus Myeloma Effect: A Single Institution Experience

Due in part to a potential graft versus myeloma effect, allogeneic stem cell transplantation is a potentially curative treatment modality in patients with multiple myeloma (MM). Initial attempts have been hampered by the high transplant-related mortality in this setting. With a reduction of toxicity, allogeneic transplant approaches with reduced-intensity conditioning (RIC) have been utilized, although they are subject to continued disease progression and relapse following transplantation. We analyze here the experience of allografting four patients with MM in a single institution, along a 16-years period in which a total of 152 individuals where allografted, using a reduced-intensity conditioning regimen; three of the patients have had previous autografts. All patients engrafted successfully and a graft versus-myeloma effect was shown in all of them. One patient relapsed in the face of graft versus host disease (GVHD). Three patients have died (two as a result of GVHD) and one is alive with a limited form of chronic GVHD. The graft versus myeloma effect can be induced by means of allogeneic transplantation but the morbidity and mortality associated with the procedure leads into a relatively small proportion of MM patients being cured.