![[Visit Client Website]](images/banner.gif)
Background:
Allogeneic bone marrow transplantation (allo-BMT) in Multiple Myeloma (MM) offers a potential curative strategy. This study was undertaken to determine outcomes of patients with MM undergoing allogeneic BMT at Temple University Hospital over the past 18 years.
Methods:
We retrospectively reviewed our clinical database for patients with a diagnosis of MM who underwent an allo-BMT between 1994 to present. We reviewed the following variables: Age, sex, myeloma subtype and stage, remission status prior to transplant, stem cell source and degree of donor matching, conditioning regimen, GVHD prophylaxis. Outcome measures included overall survival, non-relapsed mortality (NRM), and acute and chronic GVHD.
Results:
Patient characteristics are summarized in the Table 1. The median age was 49.5 years, 72.7% had DSS III, 68% had either at least PR2, PD or SD/MR, and 86.3% had a MRD transplant. The outcomes are summarized in Table 2. The median actuarial overall survival for the cohort is 5.95 years and the ten year actuarial survival for the cohort is 34%. Median survival with a Calcineurin inhibitor (CUI) and methotrexate combination for GVHD prophylaxis was 14.4 years, as compared to 2.2 years for CUI and mycophenolate based regimens (p = 0.05). The relapse rate for the cohort was 31.8%, Grade 3 or more acute GVHD developed in 31.8%, while extensive chronic GVHD occurred in 30% of the patients.
Conclusion:
Allogeneic transplantation is a reasonable strategy in patients with MM which can lead to long-term survival. Patients receiving GVHD prophylaxis with a CUI and Methotrexate experienced superior survival compared to those receiving a CUI and mycophenolate based regimen.
Table 1: Patient Characteristics (N = 22) | |
| N (%) |
Median Age (years) | 49.5 |
Sex: Male | 8 (36) |
Myeloma Subtype: Kappa light chain Lambda light chain IgA IgG Minimally secretory | 2 (9.1) 3 (13.6) 3 (13.6) 13 (59.1) 1 (4.5) |
DSS: I II III | 3 (13.6) 3 (13.6) 16 (72.7) |
Response prior to transplant: CR PR1 PR2+ SD/MR PD Unknown | 2 (9.1) 4 (18.2) 8 (36.4) 5 (22.7) 2 (9.1) 1 (4.5) |
Donor: MUD MRD | 3 (13.6) 19 (86.3) |
HLA-matching: 9/10 10/10 | 10 (45.5) 12 (54.5) |
Conditioning regimen: FLU/CY FLU/MEL FLU/MEL/ATG MEL/TBI TBI | 1 (4.5) 8 (36.4) 2 (9.1) 9 (40.9) 2 (9.1) |
Source of Stem Cells: Peripheral Blood Bone Marrow | 8 (36.4) 14 (63.6) |
GVHD prophylaxis: CYA CYA/MTX CYA/MYC TAC/MTX TAC/MYC | 1 (4.5) 8 (36.4) 2 (9.1) 2 (.1) 9 (40.9) |
Table 2: Transplant Outcomes | |
Median OS (years) | 5.9548 |
Acute GVHD Grade:
0-2
3-5 | 15 (68.2) 7 (31.8) |
Chronic GVHD: None Limited Extensive | 10 (50) 4 (20) 6 (30) |
NRM at 1 year | 7 (35%) |
Median Survival (years) per GVHD prophylaxis regimen: Calcineurin inhibitor/MTX Calcineurin inhibitor/MYC | 14.4 2.3 |