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Yin X, Tang L, Fan F, Jiang Q, Sun C, Hu Y. Allogeneic stem-cell transplantation for multiple myeloma: a systematic review and meta-analysis from 2007 to 2017. Cancer Cell Int 2018; 18:62. [PMID: 29713245 PMCID: PMC5913895 DOI: 10.1186/s12935-018-0553-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 04/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Despite recent advances, multiple myeloma (MM) remains incurable. However, the appearance of allogeneic stem cell transplantation (allo-SCT) through graft-versus-myeloma effect provides a potential way to cure MM to some degree. This systematic review aimed to evaluate the outcome of patients receiving allo-SCT and identified a series of prognostic factors that may affect the outcome of allo-SCT. Patients/methods We systematically searched PubMed, Embase, and the Cochrane Library from 2007.01.01 to 2017.05.03 using the keywords ‘allogeneic’ and ‘myeloma’. Results A total of 61 clinical trials involving 8698 adult patients were included. The pooled estimates (95% CI) for overall survival (OS) at 1, 2, 3 and 5 years were 70 (95% CI 56–84%), 62 (95% CI 53–71%), 52 (95% CI 44–61%), and 46 (95% CI 40–52%), respectively; for progression-free survival were 51 (95% CI 38–64%), 40 (95% CI 32–48%), 34 (95% CI 27–41%), and 27 (95% CI 23–31%), respectively; and for treatment-related mortality (TRM) were 18 (95% CI 14–21%), 21 (95% CI 17–25%), 20 (95% CI 13–26%), and 27 (95% CI 21–33%), respectively. Additionally, the pooled 100-day TRM was 12 (95% CI 5–18%). The incidences of grades II–IV acute graft-versus-host disease (GVHD) and chronic GVHD were 34 (95% CI 30–37%) and 51 (95% CI 46–56%), respectively. The incidences of relapse rate (RR) and death rate were 50 (95% CI 45–55%) and 51 (95% CI 45–57%), respectively. Importantly, disease progression was the most major cause of death (48%), followed by TRM (44%). The results failed to show an apparent benefit of allo-SCT for standard risk patients, compared with tandem auto-SCT. In contrast, all 14 trials in our study showed that patients with high cytogenetic risk after allo-SCT had similar OS and PFS compared to those with standard risk, suggesting that allo-SCT may overcome the adverse prognosis of high cytogenetic risk. Conclusion Due to the lack of consistent survival benefit, allo-SCT should not be considered as a standard of care for newly diagnosed and relapsed standard-risk MM patients. However, for patients with high-risk MM who have a poor long-term prognosis, allo-SCT may be a strong consideration in their initial course of therapy or in first relapse after chemotherapy, when the risk of disease progression may outweigh the transplant-related risks. A large number of prospective randomized controlled trials were needed to prove the benefits of these therapeutic options. Electronic supplementary material The online version of this article (10.1186/s12935-018-0553-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xuejiao Yin
- 1Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China
| | - Liang Tang
- 1Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China
| | - Fengjuan Fan
- 1Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China
| | - Qinyue Jiang
- 2Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China
| | - Chunyan Sun
- 1Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China.,2Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China
| | - Yu Hu
- 1Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China.,2Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China
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2
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Gay F, Engelhardt M, Terpos E, Wäsch R, Giaccone L, Auner HW, Caers J, Gramatzki M, van de Donk N, Oliva S, Zamagni E, Garderet L, Straka C, Hajek R, Ludwig H, Einsele H, Dimopoulos M, Boccadoro M, Kröger N, Cavo M, Goldschmidt H, Bruno B, Sonneveld P. From transplant to novel cellular therapies in multiple myeloma: European Myeloma Network guidelines and future perspectives. Haematologica 2018; 103:197-211. [PMID: 29217780 PMCID: PMC5792264 DOI: 10.3324/haematol.2017.174573] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 12/05/2017] [Indexed: 12/20/2022] Open
Abstract
Survival of myeloma patients has greatly improved with the use of autologous stem cell transplantation and novel agents, such as proteasome inhibitors, immunomodulatory drugs and monoclonal antibodies. Compared to bortezomib- and lenalidomide-based regimens alone, the addition of high-dose melphalan followed by autologous transplantation significantly improves progression-free survival, although an overall survival benefit was not observed in all trials. Moreover, follow up of recent trials is still too short to show any difference in survival. In the light of these findings, novel agent-based induction followed by autologous transplantation is considered the standard upfront treatment for eligible patients (level of evidence: 1A). Post-transplant consolidation and maintenance treatment can further improve patient outcome (1A). The availability of several novel agents has led to the development of multiple combination regimens such as salvage treatment options. In this context, the role of salvage autologous transplantation and allotransplant has not been extensively evaluated. In the case of prolonged remission after upfront autologous transplantation, another autologous transplantation at relapse can be considered (2B). Patients who experience early relapse and/or have high-risk features have a poor prognosis and may be considered as candidates for clinical trials that, in young and fit patients, may also include an allograft in combination with novel agents (2B). Ongoing studies are evaluating the role of novel cellular therapies, such as inclusion of antibody-based triplets and quadruplets, and chimeric antigen receptor-T cells. Despite encouraging preliminary results, longer follow up and larger patient numbers are needed before the clinical use of these novel therapies can be widely recommended.
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Affiliation(s)
- Francesca Gay
- Myeloma Unit, Division of Hematology, University of Torino, Azienda-Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Italy
| | - Monika Engelhardt
- Universitätsklinikum Freiburg, Medical Department, Hematology, Oncology & Stem Cell Transplantation, Freiburg, Germany
| | - Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Ralph Wäsch
- Universitätsklinikum Freiburg, Medical Department, Hematology, Oncology & Stem Cell Transplantation, Freiburg, Germany
| | - Luisa Giaccone
- Department of Oncology, A.O.U Città della Salute e della Scienza di Torino, and Department of Molecular Biotechnology and Health Sciences, University of Torino, Italy
| | - Holger W Auner
- Centre for Haematology, Department of Medicine, Imperial College London, UK
| | - Jo Caers
- Department of Clinical Hematology, Centre Hospitalier Universitaire de Liège, Domaine Universitaire du Sart Tilman, Liège, Belgium
| | - Martin Gramatzki
- Division of Stem Cell Transplantation and Immunotherapy, 2 Medical Department, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Niels van de Donk
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Stefania Oliva
- Myeloma Unit, Division of Hematology, University of Torino, Azienda-Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Italy
| | - Elena Zamagni
- Seragnoli Institute of Hematology, Bologna University School of Medicine, Italy
| | - Laurent Garderet
- INSERM, UMR_S 938, Proliferation and Differentiation of Stem Cells, Paris, AP-HP, Hôpital Saint Antoine, Département d'Hématologie et de Thérapie Cellulaire; Sorbonne Universités, UPMC Univ Paris 06, France
| | | | - Roman Hajek
- Department of Hematooncology, University Hospital Ostrava, Czech Republic and Faculty of Medicine University of Ostrava, Czech Republic
| | - Heinz Ludwig
- Wilhelminen Cancer Research Institute, c/o Department of Medicine I, Center of Oncology, Hematology and Palliative Care, Vienna, Austria
| | - Herman Einsele
- Department of Internal Medicine II, University Hospital Würzburg, Germany
| | - Meletios Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda-Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Italy
| | - Nicolaus Kröger
- Department of Stem cell Transplantation, University Medical Center Hamburg-Eppendorf, Germany
| | - Michele Cavo
- Seragnoli Institute of Hematology, Bologna University School of Medicine, Italy
| | - Hartmut Goldschmidt
- Medizinische Klinik, Abteilung Innere Medizin V, Universitätsklinikum Heidelberg und National Centrum für Tumorerkrankungen (NCT), Heidelberg, Germany
| | - Benedetto Bruno
- Department of Oncology, A.O.U Città della Salute e della Scienza di Torino, and Department of Molecular Biotechnology and Health Sciences, University of Torino, Italy
| | - Pieter Sonneveld
- Department of Hematology, Erasmus Medical Center, Rotterdam, the Netherlands
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3
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Lia G, Brunello L, Bruno S, Carpanetto A, Omedè P, Festuccia M, Tosti L, Maffini E, Giaccone L, Arpinati M, Ciccone G, Boccadoro M, Evangelista A, Camussi G, Bruno B. Extracellular vesicles as potential biomarkers of acute graft-vs-host disease. Leukemia 2017; 32:765-773. [PMID: 28852198 DOI: 10.1038/leu.2017.277] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/31/2017] [Accepted: 08/17/2017] [Indexed: 02/06/2023]
Abstract
Acute graft-vs-host disease (GVHD) is a serious complication after allografting. We carried out an exploratory study to investigate a potential correlation of surface antigens on extracellular vesicles (EVs) and acute GVHD. EVs were extracted from serum samples from 41 multiple myeloma patients who underwent allografting. EVs were characterized by flow cytometry using a panel of 13 antibodies against specific membrane proteins that were reported to be predictive of acute GVHD. We observed a correlation between three potential biomarkers expressed on EV surface and acute GVHD onset by both logistic regression analysis and Cox proportional hazard model. In our study, CD146 (MCAM-1) was correlated with an increased risk-by almost 60%-of developing GVHD, whereas CD31 and CD140-α (PECAM-1 and PDGFR-α) with a decreased risk-by almost 40 and 60%, respectively. These biomarkers also showed a significant change in signal level from baseline to the onset of acute GVHD. Our novel study encourages future investigations into the potential correlation between EVs and acute GVHD. Larger prospective multicenter studies are currently in progress.
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Affiliation(s)
- G Lia
- A.O.U. Città della Salute e della Scienza di Torino, Dipartimento di Oncologia, SSD Trapianto Allogenico di Cellule Staminali, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università di Torino, School of Medicine, Torino, Italy
| | - L Brunello
- A.O.U. Città della Salute e della Scienza di Torino, Dipartimento di Oncologia, SSD Trapianto Allogenico di Cellule Staminali, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università di Torino, School of Medicine, Torino, Italy
| | - S Bruno
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, Centro di Biotecnologie Molecolari, Torino, Italy
| | - A Carpanetto
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, Centro di Biotecnologie Molecolari, Torino, Italy
| | - P Omedè
- A.O.U. Città della Salute e della Scienza di Torino, Dipartimento di Oncologia, SSD Trapianto Allogenico di Cellule Staminali, Torino, Italy
| | - M Festuccia
- A.O.U. Città della Salute e della Scienza di Torino, Dipartimento di Oncologia, SSD Trapianto Allogenico di Cellule Staminali, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università di Torino, School of Medicine, Torino, Italy
| | - L Tosti
- A.O.U. Città della Salute e della Scienza di Torino, Dipartimento di Oncologia, SSD Trapianto Allogenico di Cellule Staminali, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università di Torino, School of Medicine, Torino, Italy
| | - E Maffini
- A.O.U. Città della Salute e della Scienza di Torino, Dipartimento di Oncologia, SSD Trapianto Allogenico di Cellule Staminali, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università di Torino, School of Medicine, Torino, Italy
| | - L Giaccone
- A.O.U. Città della Salute e della Scienza di Torino, Dipartimento di Oncologia, SSD Trapianto Allogenico di Cellule Staminali, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università di Torino, School of Medicine, Torino, Italy
| | - M Arpinati
- Dipartimento di Ematologia e Scienze Oncologiche 'L. e A. Seràgnoli', Università di Bologna, Bologna, Italy
| | - G Ciccone
- A.O.U. Città della Salute e della Scienza di Torino, Epidemiologia Clinica, Torino, Italy
| | - M Boccadoro
- A.O.U. Città della Salute e della Scienza di Torino, Dipartimento di Oncologia, SSD Trapianto Allogenico di Cellule Staminali, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università di Torino, School of Medicine, Torino, Italy
| | - A Evangelista
- A.O.U. Città della Salute e della Scienza di Torino, Epidemiologia Clinica, Torino, Italy
| | - G Camussi
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, Centro di Biotecnologie Molecolari, Torino, Italy
| | - B Bruno
- A.O.U. Città della Salute e della Scienza di Torino, Dipartimento di Oncologia, SSD Trapianto Allogenico di Cellule Staminali, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università di Torino, School of Medicine, Torino, Italy
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4
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Tsimbouri PM. Adult Stem Cell Responses to Nanostimuli. J Funct Biomater 2015; 6:598-622. [PMID: 26193326 PMCID: PMC4598673 DOI: 10.3390/jfb6030598] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/29/2015] [Accepted: 07/08/2015] [Indexed: 12/31/2022] Open
Abstract
Adult or mesenchymal stem cells (MSCs) have been found in different tissues in the body, residing in stem cell microenvironments called "stem cell niches". They play different roles but their main activity is to maintain tissue homeostasis and repair throughout the lifetime of an organism. Their ability to differentiate into different cell types makes them an ideal tool to study tissue development and to use them in cell-based therapies. This differentiation process is subject to both internal and external forces at the nanoscale level and this response of stem cells to nanostimuli is the focus of this review.
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Affiliation(s)
- Penelope M Tsimbouri
- Centre for Cell Engineering, Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, Joseph Black Building, University of Glasgow, Glasgow G12 8QQ, UK.
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5
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McMurray RJ, Dalby MJ, Tsimbouri PM. Using biomaterials to study stem cell mechanotransduction, growth and differentiation. J Tissue Eng Regen Med 2014; 9:528-39. [DOI: 10.1002/term.1957] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 06/11/2014] [Accepted: 08/28/2014] [Indexed: 12/22/2022]
Affiliation(s)
- Rebecca J. McMurray
- Mrksich Research Group, Department of Biomedical Engineering; Northwestern University; Evanston IL USA
| | - Matthew J. Dalby
- Centre for Cell Engineering, Institute of Molecular, Cell and Systems Biology; University of Glasgow; UK
| | - P. Monica Tsimbouri
- Centre for Cell Engineering, Institute of Molecular, Cell and Systems Biology; University of Glasgow; UK
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6
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Freytes CO, Vesole DH, LeRademacher J, Zhong X, Gale RP, Kyle RA, Reece DE, Gibson J, Schouten HC, McCarthy PL, Lonial S, Krishnan AY, Dispenzieri A, Hari PN. Second transplants for multiple myeloma relapsing after a previous autotransplant-reduced-intensity allogeneic vs autologous transplantation. Bone Marrow Transplant 2013; 49:416-21. [PMID: 24270389 PMCID: PMC3947725 DOI: 10.1038/bmt.2013.187] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 10/03/2013] [Accepted: 10/10/2013] [Indexed: 11/09/2022]
Abstract
There is no standard therapy for multiple myeloma relapsing after an autotransplant. We compared the outcomes of a second autotransplant (N=137) with those of an allotransplant (N=152) after non-myeloablative or reduced-intensity conditioning (NST/RIC) in 289 subjects reported to the CIBMTR from 1995 to 2008. NST/RIC recipients were younger (median age 53 vs 56 years; P<0.001) and had a shorter time to progression after their first autotransplant. Non-relapse mortality at 1-year post transplant was higher in the NST/RIC cohort, 13% (95% confidence interval (CI), 8-19) vs 2% (95% CI, 1-5, P0.001). Three-year PFS and OS for the NST/RIC cohort were 6% (95% CI, 3-10%) and 20% (95% CI, 14-27%). Similar outcomes for the autotransplant cohort were 12% (95% CI, 7-19%, P=0.038) and 46% (95% CI, 37-55%, P=0.001). In multivariate analyses, risk of death was higher in NST/RIC recipients (hazard ratio (HR) 2.38 (95% CI, 1.79-3.16), P<0.001), those with Karnofsky performance score<90 (HR 1.96 (95% CI, 1.47-2.62), P<0.001) and transplant before 2004 (HR 1.77 (95% CI, 1.34-2.35) P0.001). In conclusion, NST/RIC was associated with higher TRM and lower survival than an autotransplant. As disease status was not available for most allotransplant recipients, it is not possible to determine which type of transplant is superior after autotransplant failure.
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Affiliation(s)
- C O Freytes
- South Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - D H Vesole
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - J LeRademacher
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - X Zhong
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - R P Gale
- Section of Hematology, Division of Experimental Medicine, Department of Medicine, Imperial College, London, UK
| | - R A Kyle
- Mayo Clinic Rochester, Rochester, MN, USA
| | - D E Reece
- Princess Margaret Hospital, University of Toronto, Toronto, Canada
| | - J Gibson
- Royal Prince Alfred Hospital Institute of Haematology, Camperdown, Australia
| | - H C Schouten
- Interne Geneeskunde, Academische Ziekenhuis Maastricht, Maastricht, Netherlands
| | | | - S Lonial
- Emory University Hospital, Atlanta, GA, USA
| | - A Y Krishnan
- City of Hope National Medical Center, Duarte, CA, USA
| | | | - P N Hari
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
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7
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Allogeneic Stem Cell Transplantation and Targeted Immunotherapy for Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 13 Suppl 2:S330-48. [DOI: 10.1016/j.clml.2013.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 05/06/2013] [Indexed: 11/17/2022]
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8
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Passera R, Pollichieni S, Brunello L, Patriarca F, Bonifazi F, Montefusco V, Falda M, Montanari M, Guidi S, Giaccone L, Mordini N, Carella AM, Bavaro P, Milone G, Benedetti F, Ciceri F, Scimè R, Benedetti E, Castagna L, Festuccia M, Rambaldi A, Bacigalupo A, Corradini P, Bosi A, Boccadoro M, Bandini G, Fanin R, Bruno B. Allogeneic hematopoietic cell transplantation from unrelated donors in multiple myeloma: study from the Italian Bone Marrow Donor Registry. Biol Blood Marrow Transplant 2013; 19:940-8. [PMID: 23538113 DOI: 10.1016/j.bbmt.2013.03.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 03/21/2013] [Indexed: 11/12/2022]
Abstract
To evaluate trends in allografting from unrelated donors, we conducted a study on 196 consecutive myeloma patients transplanted between 2000 and 2009 in Italy. Twenty-eight percent, 37%, and 35%, respectively, received myeloablative, reduced-intensity, and nonmyeloablative conditioning. In these 3 cohorts, 1-year and 5-year transplantation-related mortalities were 28.8% and 37.0%, 20.3% and 31.3%, and 25.0% and 30.3%, respectively (P = .745). Median overall survival (OS) and event-free survival from transplantation for the 3 cohorts were 29 and 10 months, 11 and 6 months, and 32 and 13 months, respectively (P = .039 and P = .049). Overall cumulative incidences of acute and chronic graft-versus-host-disease (GVHD) were 46.1% and 51.1%. By Cox multivariate analyses, chronic GVHD was significantly associated with longer OS (hazard ratio [HR], .51; P = .009), whereas the use of peripheral blood stem cells was borderline significant (HR, .55; P = .051). Better response posttransplantation was associated with longer event-free survival (HR, 2.13 to 4.25; P < .001). Acute GVHD was associated with poorer OS (HR, 2.53; P = .001). This analysis showed a strong association of acute and chronic GVHD and depth of response posttransplantation with clinical outcomes. Long-term disease control remains challenging regardless of the conditioning. In the light of these results, prospective trials may be designed to better define the role of allografting from unrelated donors in myeloma.
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Affiliation(s)
- Roberto Passera
- Divison of Nuclear Medicine 2, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Torino, Italy
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9
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Kröger N, Zabelina T, Klyuchnikov E, Kropff M, Pflüger KH, Burchert A, Stübig T, Wolschke C, Ayuk F, Hildebrandt Y, Bacher U, Badbaran A, Schilling G, Hansen T, Atanackovic D, Zander AR. Toxicity-reduced, myeloablative allograft followed by lenalidomide maintenance as salvage therapy for refractory/relapsed myeloma patients. Bone Marrow Transplant 2012; 48:403-7. [DOI: 10.1038/bmt.2012.142] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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10
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El-Cheikh J, Crocchiolo R, Boher JM, Furst S, Stoppa AM, Ladaique P, Faucher C, Calmels B, Castagna L, Lemarie C, De Colella JMS, Coso D, Bouabdallah R, Chabannon C, Blaise D. Comparable outcomes between unrelated and related donors after reduced-intensity conditioning allogeneic hematopoietic stem cell transplantation in patients with high-risk multiple myeloma. Eur J Haematol 2012; 88:497-503. [DOI: 10.1111/j.1600-0609.2012.01777.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Nivison-Smith I, Dodds AJ, Doocey R, Ganly P, Gibson J, Ma DDF, Simpson JM, Szer J, Bradstock KF. Allogeneic hematopoietic cell transplant for multiple myeloma using reduced intensity conditioning therapy, 1998-2006: factors associated with improved survival outcome. Leuk Lymphoma 2011; 52:1727-35. [PMID: 21864043 DOI: 10.3109/10428194.2011.582201] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study reports on the outcome of 95 allogeneic hematopoietic cell transplants (HCTs) using reduced intensity conditioning (RIC) performed for patients with multiple myeloma (MM) in Australia and New Zealand between 1998 and 2006. The median age at HCT was 52 years. Of the 32 patients for whom the allograft was performed as a first transplant, 15 (47%) had their allograft less than 1 year from diagnosis, while for the 63 patients who had an allograft following an autograft, nine (14%) were allografted within 1 year post-diagnosis (p < 0.001). The cumulative incidence of transplant-related mortality (TRM) was 19% at 1 year post-transplant. At 5 years post-transplant the overall survival (OS) was 40% and progression-free survival (PFS) was 23%, with no apparent survival plateau. Three factors were independently favorable predictors of OS in a Cox regression model: immunoglobulin G (IgG) myeloma (hazard ratio [HR] = 0.42, 95% confidence interval [CI] 0.24-0.75, p = 0.004), a human leukocyte antigen (HLA)-identical sibling donor (HR = 0.37, 95% CI 0.18-0.74, p = 0.005), and less than 1 year between MM diagnosis and RIC HCT (HR = 0.27, 95% CI 0.12-0.59, p = 0.001). Patterns of outcome indicate that RIC HCT may offer the potential for cure for only a small group of patients with MM.
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Affiliation(s)
- Ian Nivison-Smith
- Australasian Bone Marrow Transplant Recipient Registry, Darlinghurst, NSW, Australia.
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12
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Allogeneic stem cell transplantation in multiple myeloma relapsed after autograft: a multicenter retrospective study based on donor availability. Biol Blood Marrow Transplant 2011; 18:617-26. [PMID: 21820394 DOI: 10.1016/j.bbmt.2011.07.026] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 07/29/2011] [Indexed: 01/08/2023]
Abstract
Allogeneic stem cell transplantation (allo-SCT) using reduced-intensity conditioning (RIC) is a feasible procedure in selected patients with relapsed multiple myeloma (MM), but its efficacy remains a matter of debate. The mortality and morbidity related to the procedure and the rather high relapse risk make the use of allo-SCT controversial. In addition, the availability of novel antimyeloma treatments, such as bortezomib and immunomodulatory agents, have made allo-SCT less appealing to clinicians. We investigated the role of RIC allo-SCT in patients with MM who relapsed after autologous stem cell transplantation and were then treated with a salvage therapy based on novel agents. This study was structured similarly to an intention-to-treat analysis and included only those patients who underwent HLA typing immediately after the relapse. Patients with a donor (donor group) and those without a suitable donor (no-donor group) were compared. A total of 169 consecutive patients were evaluated retrospectively in a multicenter study. Of these, 75 patients found a donor and 68 (91%) underwent RIC allo-SCT, including 24 from an HLA-identical sibling (35%) and 44 from an unrelated donor (65%). Seven patients with a donor did not undergo allo-SCT for progressive disease or concomitant severe comorbidities. The 2-year cumulative incidence of nonrelapse mortality was 22% in the donor group and 1% in the no-donor group (P < .0001). The 2-year progression-free survival (PFS) was 42% in the donor group and 18% in the no-donor group (P < .0001). The 2-year overall survival (OS) was 54% in the donor group and 53% in the no-donor group (P = .329). In multivariate analysis, lack of a donor was a significant unfavorable factor for PFS, but not for OS. Lack of chemosensitivity after salvage treatment and high-risk karyotype at diagnosis significantly shortened OS. In patients who underwent allo-SCT, the development of chronic graft-versus-host disease had a significant protective effect on OS. This study provides evidence for a significant PFS benefit of salvage treatment with novel drugs followed by RIC allo-SCT in patients with relapsed MM who have a suitable donor.
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Nivison-Smith I, Dodds AJ, Doocey R, Ganly P, Gibson J, Ma DDF, Simpson JM, Szer J, Bradstock KF. Allogeneic hematopoietic cell transplant for multiple myeloma using reduced intensity conditioning therapy, 1998–2006: factors associated with improved survival outcome. Leuk Lymphoma 2011. [DOI: 10.3109/01443615.2011.582201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
PURPOSE OF REVIEW The role of allogeneic stem cell transplantation (SCT) in treatment of myeloma patients is still controversial. Meanwhile, the numbers of unrelated SCT for hematological diseases in Europe are higher than for human leukocyte antigen (HLA)-identical sibling transplantations, but in multiple myeloma only 39% of the allogeneic transplantations are performed from unrelated donors and only a minority were done within prospective clinical trials. RECENT FINDINGS The few published data of unrelated SCT in multiple myeloma reported a higher treatment-related mortality for standard myeloablative conditioning in comparison to reduced-intensity conditioning. Despite the heterogeneous patient selection in the trial, lower nonrelapse mortality and improved survival can be achieved by careful donor selection (10/10 HLA-alleles, male donor). Natural killer-alloreactivity might play a role, but conclusive data are lacking. Transplantation in more advanced or refractory patients is associated with an inferior outcome. The results of an unrelated SCT seem to be comparable to those of HLA-identical siblings, but a direct comparison is lacking so far. SUMMARY Unrelated SCT in multiple myeloma is feasible, but prospective clinical trials using unrelated stem cell donors are urgently needed to define the role of an unrelated SCT in multiple myeloma in the era of novel agents.
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Elliott BM, Peti S, Osman K, Scigliano E, Lee D, Isola L, Kostakoglu L. Combining FDG-PET/CT with laboratory data yields superior results for prediction of relapse in multiple myeloma*. Eur J Haematol 2011; 86:289-98. [DOI: 10.1111/j.1600-0609.2010.01575.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Allogeneic hematopoietic stem cell transplantation in multiple myeloma has been performed since the 1980th, but is still a controversial treatment modality. The aim is to cure the disease and the rational is to eradicate myeloma cells by the dual effect of high dose myeloablative treatment, and the immune reaction against the myeloma cells by the graft (graft versus myeloma =GVM). At the same time the patient is saved from myeloablation by the normal allogeneic donor stem cells. Although outcome has improved with time the transplant related mortality using myeloablation is still high. Therefore reduced intensity non-myelablative conditioning (RIC) has increasingly substituted myeloablation and results have improved. Out of five published or ongoing prospective clinical trials using tandem autologous (ASCT) - RIC-allogeneic transplantation (RIC-allo) compared to tandem or single ASCT the tandem ASCT-RIC-Allo approach was superior. Attempts to improve outcome by adding new drugs ( thalidomide, bortezomib or lenalidomide ) or alternative cell therapies like donor T-cell infusions or NK cell treatment may improve results.
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Affiliation(s)
- Gösta Gahrton
- Department of Medicine, Karolinska Institutet and Karolinska University Hospital Huddinge, Stockholm, Sweden.
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Abstract
Solitary plasmocytoma occurring in bone (solitary plasmocytoma of the bone, SBP) or in soft tissue (extramedullary plasmocytoma, EP) can be treated effectively and with little toxicity by local radiotherapy. Ten-year local control rates of up to 90% can be achieved. Patients with multiple myeloma often suffer from symptoms such as pain or neurological impairments that are amenable to palliative radiotherapy. In a palliative setting, short treatment schedules and lower radiation doses are used to reduce toxicity and duration of hospitalization. In future, low-dose total body irradiation (TBI) may play a role in a potentially curative regimen with nonmyeloablative conditioning followed by allogenic peripheral blood stem cell transplantation.
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Affiliation(s)
- Sonja Krause
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
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Tacrolimus and mycofenolate mofetil as GvHD prophylaxis following nonmyeloablative conditioning and unrelated hematopoietic SCT for adult patients with advanced hematologic diseases. Bone Marrow Transplant 2010; 46:747-55. [DOI: 10.1038/bmt.2010.167] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Pavletic SZ, Kumar S, Mohty M, de Lima M, Foran JM, Pasquini M, Zhang MJ, Giralt S, Bishop MR, Weisdorf D. NCI First International Workshop on the Biology, Prevention, and Treatment of Relapse after Allogeneic Hematopoietic Stem Cell Transplantation: report from the Committee on the Epidemiology and Natural History of Relapse following Allogeneic Cell Transplantation. Biol Blood Marrow Transplant 2010; 16:871-90. [PMID: 20399876 DOI: 10.1016/j.bbmt.2010.04.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 04/07/2010] [Indexed: 11/19/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (alloHSCT) is increasingly being used for treatment of hematologic malignancies, and the immunologic graft-versus-tumor effect (GVT) provides its therapeutic effectiveness. Disease relapse remains a cause of treatment failure in a significant proportion of patients undergoing alloHSCT without improvements over the last 2-3 decades. We summarize here current data and outline future research regarding the epidemiology, risk factors, and outcomes of relapse after alloHSCT. Although some factors (eg, disease status at alloHSCT or graft-versus-host disease [GVHD] effects) are common, other disease-specific factors may be unique. The impact of reduced-intensity regimens on relapse and survival still need to be assessed using contemporary supportive care and comparable patient populations. The outcome of patients relapsing after an alloHSCT generally remains poor even though interventions including donor leukocyte infusions can benefit some patients. Trials examining targeted therapies along with improved safety of alloHSCT may result in improved outcomes, yet selection bias necessitates prospective assessment to gauge the real contribution of any new therapies. Ongoing chronic GVHD (cGVHD) or other residual post-alloHSCT morbidities may limit the applicability of new therapies. Developing strategies to promptly identify patients as alloHSCT candidates, while malignancy is in a more treatable stage, could decrease relapses rates after alloHSCT. Better understanding and monitoring of minimal residual disease posttransplant could lead to novel preemptive treatments of relapse. Analyses of larger cohorts through multicenter collaborations or registries remain essential to probe questions not amenable to single center or prospective studies. Studies need to provide data with detail on disease status, prior treatments, biologic markers, and posttransplant events. Stringent statistical methods to study relapse remain an important area of research. The opportunities for improvement in prevention and management of post-alloHSCT relapse are apparent, but clinical discipline in their careful study remains important.
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Karlin L, Arnulf B, Chevret S, Ades L, Robin M, De Latour RP, Malphettes M, Kabbara N, Asli B, Rocha V, Fermand JP, Socie G. Tandem autologous non-myeloablative allogeneic transplantation in patients with multiple myeloma relapsing after a first high dose therapy. Bone Marrow Transplant 2010; 46:250-6. [DOI: 10.1038/bmt.2010.90] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Osman K, Elliott B, Mandeli J, Scigliano E, Malone A, Isola L, Grosskreutz C. Non-myeloablative conditioning and allogeneic transplantation for multiple myeloma. Am J Hematol 2010; 85:249-54. [PMID: 20162541 DOI: 10.1002/ajh.21633] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In multiple myeloma (MM), allogeneic stem cell transplantation (alloHCT) carries a lower relapse risk than autologous transplantation but a greater transplant-related mortality. Nonmyeloablative conditioning for allogeneic transplantation (NST) reduces transplant-related toxicity. Results are encouraging when used during first remission in low-risk patients, but less-so in relapsed or refractory disease. This is a single-center retrospective analysis of 20 previously treated MM patients who underwent NST from matched-related or matched-unrelated donors from 2000-2006. Median age was 52.7 years (37.2-68.0). Twenty-five percent had advanced or high-risk disease. Eleven still had active disease prior to NST. Conditioning was total body irradiation 200 cGy on a single fraction on day -5, followed by antithymocyte globulin (ATG) 1.5 mg/kg/day and fludarabine 30 mg/m(2)/day on days -4 to -2. All received immunosuppression, most commonly with oral mycofenylate mofetil and cyclosporine beginning on day -5. At day 100, 50% had achieved complete remission. Transplant-related mortality was 25%. Median overall survival (OS) was 21.2 months (0.6-90+) and progression-free survival (PFS) 6.6 months (0.6-90+). Both OS and PFS were 24% at 3 years. OS was significantly greater for patients with age <52 years (median 27 months vs. 7.9 months, P = 0.031), and there was a trend toward greater OS for those with beta2 microglobulin <2.5 mg/l (median 27 months vs. 7.7 months, P = 0.08). Donor characteristics and Ig type had no significant effect on survival. These data suggest a benefit of NST in relapsed/refractory MM. Randomized trials must be performed to confirm and further qualify this benefit.
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Kröger N, Shimoni A, Schilling G, Schwerdtfeger R, Bornhäuser M, Nagler A, Zander AR, Heinzelmann M, Brand R, Gahrton GÃ, Morris C, Niederwieser D, de Witte T. Unrelated stem cell transplantation after reduced intensity conditioning for patients with multiple myeloma relapsing after autologous transplantation. Br J Haematol 2010; 148:323-31. [DOI: 10.1111/j.1365-2141.2009.07984.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schiffer JT, Kirby K, Sandmaier B, Storb R, Corey L, Boeckh M. Timing and severity of community acquired respiratory virus infections after myeloablative versus non-myeloablative hematopoietic stem cell transplantation. Haematologica 2009; 94:1101-8. [PMID: 19644142 DOI: 10.3324/haematol.2008.003186] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Respiratory virus infections are important causes of morbidity and mortality after hematopoietic cell transplantation. Their clinical course can be severe with progression to lower respiratory tract infection, co-infection with serious pulmonary co-pathogens, and high mortality. Non-myeloablative conditioning regimens achieve engraftment without eradication of host hematopoietic cells, which potentially allows for protection against infections commonly seen in hematopoietic cell transplantation patients treated with standard intensity conditioning regimens. DESIGN AND METHODS We performed a retrospective cohort study to measure the incidence and severity of parainfluenza types 1-4, influenza (A and B), respiratory syncitial virus and human rhinovirus disease in myeloablative versus non-myeloablative versus autologous hematopoietic cell transplantation patients. RESULTS The incidences of all respiratory virus infections were similar in the non-myeloablative and myeloablative cohorts but less in the autologous cohort (33/420 [7.9%], 150/1593 [9.4%], and 37/751 [4.9%], respectively, p<0.0001). However, respiratory virus lower tract infections were significantly less common during the first 100 days after transplantation in non-myeloablative patients compared to myeloablative and autologous patients (1/420 [0.2%], 34/1593 [2.1%] and 16/751 [2.1%], respectively, p=0.005. Respiratory virus lower tract infection had high co-infection and attributable mortality rates. CONCLUSIONS Respiratory virus lower tract infection during the first 100 days after hematopoietic cell transplantation was less common in persons receiving non-myeloablative conditioning regimens compared to myeloablative conditioning, despite a similar overall rate of acquisition.
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Abstract
Multiple myeloma is characterised by clonal proliferation of malignant plasma cells, and mounting evidence indicates that the bone marrow microenvironment of tumour cells has a pivotal role in myeloma pathogenesis. This knowledge has already expanded treatment options for patients with multiple myeloma. Prototypic drugs thalidomide, bortezomib, and lenalidomide have each been approved for the treatment of this disease by targeting both multiple myeloma cells and the bone marrow microenvironment. Although benefit was first shown in relapsed and refractory disease, improved overall response, duration of response, and progression-free and overall survival can be achieved when these drugs are part of first-line regimens. This treatment framework promises to improve outcome not only for patients with multiple myeloma, but also with other haematological malignancies and solid tumours.
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Affiliation(s)
- Marc S Raab
- LeBow Institute for Myeloma Therapeutics and Jerome Lipper Center for Multiple Myeloma Research, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
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Vesole DH, Zhang L, Flomenberg N, Greipp PR, Lazarus HM, Huff CA. A Phase II trial of autologous stem cell transplantation followed by mini-allogeneic stem cell transplantation for the treatment of multiple myeloma: an analysis of Eastern Cooperative Oncology Group ECOG E4A98 and E1A97. Biol Blood Marrow Transplant 2009; 15:83-91. [PMID: 19135946 DOI: 10.1016/j.bbmt.2008.10.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Accepted: 10/30/2008] [Indexed: 10/21/2022]
Abstract
Conventional allogeneic hematopoietic stem cell transplantation (HSCT) for multiple myeloma is associated with high transplantation-related mortality (TRM). Nonmyeloablative allogeneic transplantation (NST) uses the well-known graft-versus-myeloma (GVM) effect to eradicate minimal residual disease. The Eastern Cooperative Oncology Group conducted a Phase II trial of autologous HSCT followed by NST to provide maximal tumor cytoreduction to allow for a subsequent GVM effect. Patients received melphalan 200 mg/m(2) with autologous HSCT, followed by fludarabine 30 mg/m(2) in 5 daily doses and cyclophosphamide 1 g/m(2) in 2 daily doses with matched sibling donor NST. Graft-versus-host disease (GVHD) prophylaxis included cyclosporine and corticosteroids. The primary endpoints were TRM, graft failure, acute GVHD, progression-free survival (PFS), and overall survival (OS). Thirty-two patients were enrolled into the study; 23 patients completed both transplantations (72%). Best responses post-NST were 7 (30%) complete remission (CR), 11 (48%) partial remission (PR), 2 (9%) no response, and 3 (13%) not evaluable. Acute grade III-IV GVHD was observed in 4 patients (17%), and chronic GVHD was seen in 13 patients (57%; 7 limited, 6 extensive). Chronic GVHD resulted in the following responses: 3 (23%) CR, 1 continuing CR, and 6 (46%) PR. Two patients (8.7%) had early TRM. With a median follow up of 4.6 years, the median PFS was 3.6 years, and the 2-year OS was 78%. Our findings indicate that autologous HSCT followed by NST is feasible, with a low early TRM in a cooperative group setting. The overall response rate was 78%, including 30% CR, similar to other reports for autologous HSCT-NST. Because a plateau in PFS or OS was not observed with this treatment approach even in patients achieving CR, we suggest that future studies use posttransplantation maintenance therapy.
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Affiliation(s)
- David H Vesole
- Department of Medicine, St Vincent's Comprehensive Cancer Center, New York, New York, USA.
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Kornblit B, Masmas T, Madsen HO, Ryder LP, Svejgaard A, Jakobsen B, Sengeløv H, Olesen G, Heilmann C, Dickmeiss E, Petersen SL, Vindeløv L. Haematopoietic cell transplantation with non-myeloablative conditioning in Denmark: disease-specific outcome, complications and hospitalization requirements of the first 100 transplants. Bone Marrow Transplant 2008; 41:851-9. [DOI: 10.1038/bmt.2008.10] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Current Awareness in Hematological Oncology. Hematol Oncol 2007. [DOI: 10.1002/hon.798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Abstract
The recognition that the immune system can play a major role in the control and cure of transplantable disorders led to the development of reduced-intensity allogeneic transplantation. The notion is that a compromise can be made between the intensity of conditioning and the fostering of graft-versus-host disease/ graft-versus-leukemia (GVHD/GVL), allowing the use of less intense conditioning with concomitantly less intense immediate toxicity. Reduced-intensity conditioning regimens have allowed the application of transplantation to older patients and to patients with underlying medical problems that preclude full-dose transplantation. Clearly, in some settings in which dose intensity is important, reduced-intensity regimens are less useful. However, for diseases that are either indolent, highly susceptible to GVL, or under good control before entering transplantation, this approach appears to have substantial benefits. Although the therapy appears to be valuable, concerns about delayed immune reconstitution and GVHD remain.
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