TY - JOUR
T1 - CD34-Selected Allogeneic Hematopoietic Stem Cell Transplantation for Patients with Relapsed, High-Risk Multiple Myeloma
AU - Smith, Eric
AU - Devlin, Sean M.
AU - Kosuri, Satyajit
AU - Orlando, Evelyn
AU - Landau, Heather
AU - Lesokhin, Alex M.
AU - Chung, David J.
AU - Hassoun, Hani
AU - Lendvai, Nikoletta
AU - Landgren, Ola
AU - Giralt, Sergio
AU - Chari, Ajai
AU - Jagannath, Sundar
AU - Koehne, Guenther
N1 - Publisher Copyright:
© 2016 American Society for Blood and Marrow Transplantation.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - We report results of a retrospective analysis of 44 patients with relapsed and high-risk multiple myeloma (MM) undergoing allogeneic CD34-selected hematopoietic stem cell transplantation (HSCT) from HLA-compatible donors. Patients had multiply relapsed disease including relapse at <15 months after autologous transplantation and most patients (28 of 44; 65%) also had high-risk cytogenetics. Before transplantation, patients received busulfan (8 mg/kg × 10 doses), melphalan (70 mg/m2 × 2 days), fludarabine (25 mg/m2 × 5 days), and rabbit antithymocyte globulin (2.5 mg/kg × 2 days). Patients with 10/10 HLA- matched donors were treated prophylactically with low doses of donor lymphocyte infusions (5 to 1 × 106 CD3+/kg) starting 4 to 6 months after CD34-selected HSCT. Acute (grade II to IV) graft-versus-host disease (GVHD) and transplantation-related mortality at 12 months were 2% and 18%, respectively. Chronic GVHD was not observed in any patient. Overall and progression-free survival at 2 years were 54% and 31%, respectively. By multivariate analyses, the outcomes of CD34-selected HSCT were influenced by presence of extramedullary disease, disease status before CD34-selected HSCT, and age. This study demonstrates notable safety and efficacy of CD34-selected HSCT in patients with multiply relapsed MM, including those with high-risk cytogenetics.
AB - We report results of a retrospective analysis of 44 patients with relapsed and high-risk multiple myeloma (MM) undergoing allogeneic CD34-selected hematopoietic stem cell transplantation (HSCT) from HLA-compatible donors. Patients had multiply relapsed disease including relapse at <15 months after autologous transplantation and most patients (28 of 44; 65%) also had high-risk cytogenetics. Before transplantation, patients received busulfan (8 mg/kg × 10 doses), melphalan (70 mg/m2 × 2 days), fludarabine (25 mg/m2 × 5 days), and rabbit antithymocyte globulin (2.5 mg/kg × 2 days). Patients with 10/10 HLA- matched donors were treated prophylactically with low doses of donor lymphocyte infusions (5 to 1 × 106 CD3+/kg) starting 4 to 6 months after CD34-selected HSCT. Acute (grade II to IV) graft-versus-host disease (GVHD) and transplantation-related mortality at 12 months were 2% and 18%, respectively. Chronic GVHD was not observed in any patient. Overall and progression-free survival at 2 years were 54% and 31%, respectively. By multivariate analyses, the outcomes of CD34-selected HSCT were influenced by presence of extramedullary disease, disease status before CD34-selected HSCT, and age. This study demonstrates notable safety and efficacy of CD34-selected HSCT in patients with multiply relapsed MM, including those with high-risk cytogenetics.
KW - Adoptive immunotherapy
KW - D34-selected hematopoietic stem cell transplantation
KW - Relapsed high-risk multiple myeloma
UR - http://www.scopus.com/inward/record.url?scp=84958647280&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2015.08.025
DO - 10.1016/j.bbmt.2015.08.025
M3 - Article
C2 - 26325439
AN - SCOPUS:84958647280
SN - 1083-8791
VL - 22
SP - 258
EP - 267
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 2
ER -