Allo SCT: High rate of remission and low rate of disease recurrence

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High rate of remission and low rate of disease recurrence in patients
with multiple myeloma allografted with PBSC from their HLA-identical sibling
donors

I Majolino1, P Corradini2, R ScimË3, M Falda4, A Bosi5, C Tarella4, M
Musso6, A Olivieri7, M Boccadoro4, R MarcenÚ3, A Santoro3 and A Pileri4

1Hematology and Bone Marrow Transplantation Unit, Azienda Ospedaliera
S.Camillo-Forlanini, Roma

2Bone Marrow Transplantation Unit, Istituto Nazionale Tumori, Milan

3Division of Hematology, Ospedale V.Cervello, Palermo

4Hospital and University Divisions of Hematology, Ospedale S.Giovanni
Battista, Torino

5Bone Marrow Transplantation Unit, Department of Hematology, Ospedale
di Careggi, Florence

6Unit of Onco-hematology, Casa di Cura ‘La Maddalena’, Palermo

7Hematology Department, Ospedale di Torrette, Ancona, Italy

Correspondence to: Dr I Majolino, Unit‡ Operativa di Ematologia e
Trapianti di Midollo Osseo, Azienda Ospedaliera S.Camillo-Forlanini,
Circonvallazione Gianicolense 87, 00152 Roma, Italy. E-mail:
imajolino@libero.it

Abstract

Summary:

A total of 30 multiple myeloma patients (M=23, F=7; age 31-55 years,
median 48) were allografted with peripheral blood stem cells (PBSC) from
HLA-identical siblings. Time to transplantation was 3-107 months (median 8).
Prior chemotherapy lines varied from 1 to 6 (median 1). Four patients were
in complete remission (CR), 11 in partial remission (PR), 13 were considered
to be nonresponders, and two had progressive disease. Most were conditioned
with busulfan-melphalan. PBSC were collected by apheresis after G-CSF or
sequential GM-CSF and G-CSF. The patients were grafted with 4.4-24.1 ¥
106/kg CD34+ (median 7.9) and 0.9-7.9 ¥ 108/kg CD3+ cells (median 2.3). GVHD
prophylaxis was methotrexate-cyclosporine. Engraftment was complete and
rapid. Grades II-IV acute GVHD (aGVHD) developed in 16 (53%), but was grade
III-IV only in five (17%); chronic GVHD (cGVHD) developed in 17 out of the
24 evaluable patients (71%). A total of 18 patients (71%) attained CR after
transplantation. TRM was 30% overall, 16% at 100 days. There was only one
relapse. Overall survival and event-free survival at 73 months were 60% and
67%, respectively. PCR negativity for IgH-gene rearrangement occurred in all
persistently CR patients studied. PBSC allograft can induce long remissions,
because of profound suppression of the neoplastic clone that is probably
linked to the antitumor effect of cGVHD.

Bone Marrow Transplantation (2003) 31, 767-773.
doi:10.1038/sj.bmt.1703924

Keywords

myeloma; allogeneic; transplantation; PBSC; GVHD

Received 31 May 2002; accepted 3 December 2002

May (1) 2003, Volume 31, Number 9, Pages 767-773