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Unrelated stem cell transplantation in multiple myeloma after a reduced-intensity conditioning with pretransplantation antithymocyte globulin is highly effective with low transplantation-related mortality.
- Source :
-
Blood [Blood] 2002 Dec 01; Vol. 100 (12), pp. 3919-24. Date of Electronic Publication: 2002 Aug 08. - Publication Year :
- 2002
-
Abstract
- We investigated the feasibility of unrelated stem cell transplantation in 21 patients with advanced stage II/III multiple myeloma after a reduced-intensity conditioning regimen consisting of fludarabine (150 mg/m(2)), melphalan (100-140 mg/m(2)), and antithymocyte globulin (ATG; 10 mg/kg on 3 days). The median patient age was 50 years (range, 32-61 years). All patients had received at least one prior autologous transplantation, in 9 cases as part of an autologous-allogeneic tandem protocol. No graft failure was observed. At day 40 complete donor chimerism was detected in all patients. Grade II to IV acute graft-versus-host disease (GVHD) was seen in 8 patients (38%), and severe grade III/IV GVHD was observed in 4 patients (19%). Six patients (37%) developed chronic GVHD, but only 2 patients (12%) experienced extensive chronic GVHD. The estimated probability of nonrelapse mortality at day 100 was 10% and at 1 year was 26%. After allografting, 40% of the patients achieved a complete remission, and 50% achieved a partial remission, resulting in an overall response rate of 90%. After a median follow-up of 13 months, the 2-year estimated overall and progression-free survival rates are 74% (95% CI, 54%-94%) and 53% (95% CI, 29%-87%), respectively. A shorter progression-free survival was seen in patients who already experienced relapse to prior autograft (26% versus 86%, P =.04). Dose-reduced conditioning with pretransplantation ATG followed by unrelated stem cell transplantation provides durable engraftment and donor chimerism, reduces substantially the risk of transplant-related organ toxicity, and induces high remission rates.
- Subjects :
- Adult
Antineoplastic Combined Chemotherapy Protocols administration & dosage
Antineoplastic Combined Chemotherapy Protocols toxicity
Feasibility Studies
Female
Graft vs Host Disease drug therapy
Graft vs Host Disease prevention & control
Hematopoietic Stem Cell Transplantation adverse effects
Hematopoietic Stem Cell Transplantation mortality
Humans
Male
Melphalan administration & dosage
Middle Aged
Multiple Myeloma complications
Multiple Myeloma mortality
Survival Analysis
Transplantation Conditioning mortality
Transplantation, Homologous adverse effects
Transplantation, Homologous methods
Transplantation, Homologous mortality
Treatment Outcome
Vidarabine administration & dosage
Antilymphocyte Serum administration & dosage
Hematopoietic Stem Cell Transplantation methods
Multiple Myeloma therapy
Transplantation Conditioning methods
Vidarabine analogs & derivatives
Subjects
Details
- Language :
- English
- ISSN :
- 0006-4971
- Volume :
- 100
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Blood
- Publication Type :
- Academic Journal
- Accession number :
- 12393448
- Full Text :
- https://doi.org/10.1182/blood-2002-04-1150