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The article discusses a study on the outcome of patients with recurring myeloma after reduced-intensity conditioning (RIT) allogeneic hematopoietic stem cell transplantation (SCT). The long-term results of 50 patients with refractory or recurrent multiply myeloma who were given allogeneic SCT between January 2001 and June 2004 were analyzed. It concludes that RIC allogeneic SCT can result in a long-term progression-free survival (PFS) in patients with multiple myeloma with best results attained when given early in disease course and in remission.

Objective: To investigate post-transplant immunotherapy with escalating donor-lymphocyte infusions (DLI) and novel agents (thalidomide, bortezomib, and lenalidomide) to target complete remission (CR). Materials and Methods: Thirty-two patients with multiple myeloma who achieved only partial remission after allogeneic stem cell transplantation were treated with DLI. If no CR was achieved, one of the novel agents was added to target CR. Results: CR defined either by European Group for Blood and Marrow Transplantation criteria, flow cytometry, or molecular methods as assessed by patient-specific immunoglobulin H–polymerase chain reaction or plasma cell chimerism polymerase chain reaction was accomplished in 59%, 63%, and 50% of patients, respectively. Achievement of CR resulted in improved 5-year progressive-free and overall survival, according to European Group for Blood and Marrow Transplantation criteria (53% vs 35%; p =0.03 and 90% vs 62%; p =0.06), flow cytometry (74% vs 15%; p =0.001 and 100% vs 52%; p =0.1), or molecular methods (84% vs 38%; p =0.001 and 100% vs 71%; p =0.03). Conclusions: Our finding demonstrates the clinical relevance of posttransplantation therapies to upgrade remission, and of remission''s depth for long-term survival in myeloma patients. [Copyright &y& Elsevier]

Lenalidomide may prevent relapses after allogeneic stem cell transplantation by promoting the immune-mediated graft-versus-tumor effect. We performed a prospective phase I/II study to define the dose-limiting toxicity and the immunologic effects of lenalidomide given early (day 100–180) after allograft for four cycles in patients with multiple myeloma. According to the Fibonacci design, 24 patients with a median age of 53 years were included. Dose-limiting toxicity was organ toxicity owing to graft-versus-host disease, and the maximum tolerable dose was 5 mg. The incidence of graft-versus-host disease after lenalidomide was 38%, occurring after a median of 22 days, and was beside organ toxicity, a leading cause to discontinue the study in 29% of the patients. Immune monitoring revealed a significant increase in peripheral γ-interferon–secreting CD4+ and CD8+ T cells within the first week of lenalidomide treatment followed by a delayed increase in T regulatory cells. Furthermore, natural killer (NK) cells isolated from the peripheral blood of patients evidenced a significantly improved antimyeloma activity after lenalidomide treatment. The immune effect might have contributed to the increased CR rate from 24–42% after lenalidomide treatment because nonresponding patients showed significantly less natural killer and T cell activation. (Study registered under: NCT 00778752.) [ABSTRACT FROM AUTHOR]