Multiple Myeloma (MM) is the most frequent indication for autolografting and allografting. Autografting (AutoSCT) represents the most effective palliation for these patients. Even the double AutoSCT where there is demonstrated good long-term control in a minority of patients do not appear to result in cure of disease. Myeloablative AlloSCT is penalized by excessive transplant-related mortality (TRM) and toxicity.The introduction of reduced-intensity conditioning for allografting (RICT) has renewed interest in the use of AlloSCT for MM. Recent studies have reported encouraging results with tandem AutoSCT followed shortly thereafter by RICT in MM patients as compared to AutoSCT or myeloablative AlloSCT alone. Here we present the results achieved in our Unit in patients receiving AutoSCT (single or double) compared to patients receiving tandem AutoSCT/RICT. The major results are summarized in the table. In the AutoSCT/RICT group the risk of disease progression was reduced for those patients who achieved full chimerism, acute and/or chronic GVHD. This finding confirms the existence of a graft-versus-myeloma effects. Since the first clinical signs of response of remitters patients were noted between 70 and 120 days and maximum response between 160 and 200 days after RICT (and after DLI in 2 patients) these responses should be considered immunological responses. In conclusion, these data suggest that AutoSCT/RICT significantly reduces the incidence of disease progression but did not impact on overall survival with respect to single or double AutoSCT.

SingleDoubleAutoSCT
AutoSCTAutoSCT+ RICT
(n=15)(n=35)(n=24)
Age, median 64 (range 48–73) 62 (range 35–73) 50 (range 34–63) 
No. prior cycle chemoth., median 5 (range 3–8) 4 (range 3–6) 4 (range 3–6) 
Conditioning regimen for AutoSCT Melph. 200 mg/m2 Melph. 200 mg/m2 Melph. 200 mg/m2 
Conditioning regimen for RICT ==== ==== TBI-Flu (19 pts) 
   Flu-Melph. (5 pts) 
Days from Dx to AutoSCT, median 210 (range 120–390) 320 (range 120–840)  
Days from AutoSCT to RICT ==== ==== 80 
Overall Survival 73,3% (11/15) 60% (21/35) 66% (16/24) 
Median Overall Survival 37 (range 10–132) 51 (range 13–147) 28 (range 6–87) 
Pts alive in CR 1 (6,6%) 4 (26,6%) 10 (41,6%) 
CR duration, median 20 mo. 56 mo. (range 28–70) 67 mo. (range 8–78) 
TRM 1 ==== 3 
SingleDoubleAutoSCT
AutoSCTAutoSCT+ RICT
(n=15)(n=35)(n=24)
Age, median 64 (range 48–73) 62 (range 35–73) 50 (range 34–63) 
No. prior cycle chemoth., median 5 (range 3–8) 4 (range 3–6) 4 (range 3–6) 
Conditioning regimen for AutoSCT Melph. 200 mg/m2 Melph. 200 mg/m2 Melph. 200 mg/m2 
Conditioning regimen for RICT ==== ==== TBI-Flu (19 pts) 
   Flu-Melph. (5 pts) 
Days from Dx to AutoSCT, median 210 (range 120–390) 320 (range 120–840)  
Days from AutoSCT to RICT ==== ==== 80 
Overall Survival 73,3% (11/15) 60% (21/35) 66% (16/24) 
Median Overall Survival 37 (range 10–132) 51 (range 13–147) 28 (range 6–87) 
Pts alive in CR 1 (6,6%) 4 (26,6%) 10 (41,6%) 
CR duration, median 20 mo. 56 mo. (range 28–70) 67 mo. (range 8–78) 
TRM 1 ==== 3 
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Topics:
allografting, conditioning (psychology), multiple myeloma, brachial plexus neuritis, disease progression, influenza, graft-versus-host disease, chronic, palliative care, tissue transplants, toxic effect

Author notes

Disclosure: No relevant conflicts of interest to declare.

2007, The American Society of Hematology
2007
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