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Relapse to prior autograft and chronic graft-versus-host disease are the strongest prognostic factors for outcome of melphalan/fludarabine-based dose-reduced allogeneic stem cell transplantation in patients with multiple myeloma.
- Source :
-
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation [Biol Blood Marrow Transplant] 2004 Oct; Vol. 10 (10), pp. 698-708. - Publication Year :
- 2004
-
Abstract
- We evaluated prognostic factors of melphalan/fludarabine-based dose-reduced allografts in patients with multiple myeloma. From 1998 to 2002, 120 patients with multiple myeloma were treated with melphalan/fludarabine followed by allogeneic stem cell transplantation. The cumulative risk at 1 year for treatment-related mortality (TRM) was 18% (95% confidence interval [CI], 12%-28%). In a multivariate analysis, relapse after prior high-dose chemotherapy was the most significant risk factor for TRM (hazard ratio [HR], 2.80; 95% CI, 1.16-6.74; P =.02), relapse (HR, 4.14; 95% CI, 2.04-8.38; P <.001), event-free survival (HR, 3.11; 95% CI, 1.77-5.46; P <.001), and overall survival (HR, 2.69; 95% CI, 1.35-5.35; P =.005). In addition, relapse was also significantly diminished by chronic graft-versus-host disease (GVHD) in a time-dependent Cox model (HR, 0.37; 95% CI, 0.16-0.87; P =.02). At transplantation, 8% of the patients were in complete remission, whereas 27% had progressive disease. After allografting, 49% achieved complete remission, and 38% achieved partial remission. In a subgroup of patients with chemosensitivity at transplantation and no relapse after prior high-dose chemotherapy who underwent transplantation with peripheral blood stem cells (n = 46), the cumulative risk of TRM at 1 year was only 8% (95% CI, 1%-54%). The 2-year estimated event-free and overall survival was 60% (95% CI, 42%-78%) and 75% (95% CI, 59%-91%), respectively, for related donors (n = 34) and was 81% (95% CI, 59%-100%) and 92% (95% CI, 76%-100%), respectively, for unrelated donors (n = 12).
- Subjects :
- Adult
Aged
Chronic Disease
Female
Graft Survival
Hematopoietic Stem Cell Transplantation mortality
Humans
Male
Melphalan administration & dosage
Middle Aged
Prognosis
Recurrence
Remission Induction
Salvage Therapy methods
Survival Analysis
Transplantation, Autologous
Transplantation, Homologous
Treatment Outcome
Vidarabine administration & dosage
Antineoplastic Combined Chemotherapy Protocols administration & dosage
Graft vs Host Disease mortality
Hematopoietic Stem Cell Transplantation methods
Multiple Myeloma mortality
Multiple Myeloma therapy
Vidarabine analogs & derivatives
Subjects
Details
- Language :
- English
- ISSN :
- 1083-8791
- Volume :
- 10
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 15389436
- Full Text :
- https://doi.org/10.1016/j.bbmt.2004.06.002