Reduced-intensity conditioning for myeloma: lower nonrelapse mortality but higher relapse rates compared with myeloablative conditioning

Author:

Crawley Charles1,Iacobelli Simona2,Björkstrand Bo3,Apperley Jane F.4,Niederwieser Dietger5,Gahrton Gösta,

Affiliation:

1. Addenbrooke's Hospital, Cambridge, United Kingdom;

2. Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands;

3. Karolinska University Hospital, Huddinge, Stockholm, Sweden;

4. Imperial College, Hammersmith Hospital, London, United Kingdom;

5. University of Leipzig, Germany

Abstract

Abstract Despite the widespread adoption of reduced-intensity conditioning (RIC) for myeloma, there are few data comparing outcomes with RIC with myeloablative conditioning (MAC). We report the outcomes of patients undergoing allogeneic transplantations for myeloma and reported to the EBMT. A minimum data set was available on 320 RIC and 196 MAC allografts performed between 1998 and 2002. The RIC patients were older (51 vs 45 years) with more progressive disease (28% vs 21%) and more had received a prior transplant (76% vs 11%). In addition, there was a longer time to transplantation and an increased use of peripheral blood and T-cell depletion. For RIC and MAC, respectively, the nonrelapse mortality (NRM) at 2 years was 24% and 37% (P = .002); overall survival, 38.1% and 50.8% (not significant [ns]); and progression-free survival (PFS), 18.9% and 34.5% (P = .001). On multivariate analysis, RIC was associated with a reduction in NRM (HR, 0.5), but this was offset by an increase in relapse risk (HR, 2.0), and the conditioning intensity did not impact on overall survival or retain significance for PFS. These data suggest that there is a continuing need to investigate dose intensity in the conditioning for myeloma allografts.

Publisher

American Society of Hematology

Subject

Cell Biology,Hematology,Immunology,Biochemistry

Reference23 articles.

1. Crawley C, Lalancette M, Szydlo R, et al. Outcomes for reduced intensity allogeneic transplantation for multiple myeloma: an analysis of prognostic factors from the chronic leukemia working party of the EBMT. Blood2005; 2004:2006–2387.

2. CIBMTR. 2007; http://www.cibmtr.org/services/summary_slides.html Accessed February 14.

3. Attal M, Harousseau JL, Facon T, et al. Single versus double autologous stem-cell transplantation for multiple myeloma. N Engl J Med2003; 349:2495–2502.

4. Gahrton G, Tura S, Ljungman P, et al. Prognostic factors in allogeneic bone marrow transplantation for multiple myeloma. J Clin Oncol1995; 13:1312–1322.

5. Bensinger WI, Buckner CD, Anasetti C, et al. Allogeneic marrow transplantation for multiple myeloma: an analysis of risk factors on outcome. Blood1996; 88:2787–2793.

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