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- Title
Unrelated stem cell transplantation after reduced intensity conditioning for patients with multiple myeloma relapsing after autologous transplantation.
- Authors
Kröger, Nicolaus; Shimoni, Avichai; Schilling, Georgia; Schwerdtfeger, Rainer; Bornhäuser, Martin; Nagler, Arnon; Zander, Axel R.; Heinzelmann, Marion; Brand, Ronald; Gahrton, Gösta; Morris, Curly; Niederwieser, Dietger; de Witte, Theo
- Abstract
From 2002 to 2007, 49 myeloma patients who relapsed following autologous SCT were included in a prospective multicenter trial to determine the efficacy of a reduced melphalan/fludarabine regimen followed by allogeneic SCT from unrelated donors. All patients showed leucocyte and platelet engraftment after a median of 15 and 19 d, respectively. Grade II–IV acute graft- versus-host disease (GvHD) occurred in 25% of patients and 35% had chronic GvHD. Overall response rate at day 100 was 95% including 46% complete remission (CR). Cumulative incidence of non-relapse mortality at 1 year was 25% [95% confidence interval (CI): 13–37%] and was significantly lower for human leucocyte antigen (HLA)-matched compared to -mismatched SCT (10% vs. 53%, P = 0·001). The cumulative incidence of relapse at 3 years was 55% (95% CI: 40–70%). After a median follow up of 43 months, the estimated 5-year progression-free and overall survival rates were 20% and 26% respectively and were significantly better for matched in CR at day 100 (41% vs. 7%, P = 0·04 and 56% vs. 16%, P = 0·02). We conclude that optimal donor selection is mandatory for a low non-relapse mortality and high relapse incidence, which remains a major concern, should be improved by including post-transplant strategies to upgrade remission status.
- Subjects
MULTIPLE myeloma; B cell lymphoma; STEM cell transplantation; LEUCOCYTES; FLUDARABINE
- Publication
British Journal of Haematology, 2010, Vol 148, Issue 2, p323
- ISSN
0007-1048
- Publication type
Article
- DOI
10.1111/j.1365-2141.2009.07984.x