Faculty Collaboration Database

Allogeneic Hematopoietic Cell Transplantation in Multiple Myeloma: Impact of Disease Risk and Post Allograft Minimal Residual Disease on Survival. Clin Lymphoma Myeloma Leuk 2016 Jul;16(7):379-86

Date

05/11/2016

Pubmed ID

27160644

DOI

10.1016/j.clml.2016.03.001

Scopus ID

2-s2.0-84965053091 (requires institutional sign-in at Scopus site)   15 Citations

Abstract

BACKGROUND: Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative option for multiple myeloma (MM). We analyzed our experience of allo-HCT in MM and examined outcomes in 77 consecutive patients with MM receiving allo-HCT from matched sibling (n = 69) or unrelated donors (n = 8). The primary objectives were to assess overall survival (OS), progression-free survival (PFS), and non-relapse mortality in these patients.

PATIENTS AND METHODS: Sixty-six patients received non-myeloablative/reduced-intensity conditioning regimens, while 11 received myeloablative regimens. The median follow-up of survivors was 50 months (range, 2.3-129.3 months).

RESULTS: Twenty-seven (35.1%) patients had high-risk cytogenetics at diagnosis (t (4:14), 17p deletion, chromosome 1 abnormality, or t (14:16)). All of patients except 1 had prior auto transplant. On multivariate analysis, older age (hazard ratio [HR], 1.055; 95% confidence interval [CI], 1.001 = 1.11; P = .04), less than complete remission (CR) at allo-HCT (HR, 4.3; 95% CI, 1.3-14.1; P = .006), and cytomegalovirus reactivation (HR, 3.2; 95% CI, 1.38-7.6; P = .002) were associated with higher mortality risk. Less than CR at allo-HCT was also associated with higher risk for non-relapse mortality (HR, 5.8; 95% CI, 1.3-26.3; P = .02). There was no difference in OS or PFS between high-risk and standard-risk cytogenetics. No difference in OS and PFS was seen in those who had morphological complete response regardless of the minimal residual disease status.

CONCLUSION: Allotransplant benefited younger patients and those in CR at the time of transplant. The adverse effect of high-risk cytogenetics may be overcome by the allo-HCT.

Author List

Dhakal B, D'Souza A, Martens M, Kapke J, Harrington AM, Pasquini M, Saber W, Drobyski WR, Zhang MJ, Hamadani M, Hari PN

Authors

Anita D'Souza MD Associate Professor in the Medicine department at Medical College of Wisconsin
Binod Dhakal MD Associate Professor in the Medicine department at Medical College of Wisconsin
William R. Drobyski MD Professor in the Medicine department at Medical College of Wisconsin
Mehdi H. Hamadani MD Professor in the Medicine department at Medical College of Wisconsin
Parameswaran Hari MD Adjunct Professor in the Medicine department at Medical College of Wisconsin
Alexandra M. Harrington MD Professor in the Pathology department at Medical College of Wisconsin
Michael Martens PhD Assistant Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Marcelo C. Pasquini MD, MS Professor in the Medicine department at Medical College of Wisconsin
Wael Saber MD, MS Professor in the Medicine department at Medical College of Wisconsin
Mei-Jie Zhang PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Biomarkers
Chromosome Aberrations
Disease Progression
Female
Follow-Up Studies
Graft Survival
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Humans
Immunohistochemistry
Male
Middle Aged
Multiple Myeloma
Neoplasm Staging
Neoplasm, Residual
Proportional Hazards Models
Survival Analysis
Tissue Donors
Transplantation Conditioning
Transplantation, Homologous
Treatment Outcome
Young Adult