High response rate in refractory and poor-risk multiple myeloma after allotransplantation using a nonmyeloablative conditioning regimen and donor lymphocyte infusions
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Discussion
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Implication
Clinical study demonstrates high response rates and reduced early toxicity in poor-risk multiple myeloma, indicating potent graft-versus-myeloma effects.
Key Points
- To assess the toxicity, engraftment success, and antitumor efficacy of nonmyeloablative conditioning followed by allogeneic stem cell transplantation and donor lymphocyte infusions in patients with refractory or poor-risk multiple myeloma.
- Treated 16 poor-risk multiple myeloma patients (10 refractory relapse, 4 responsive relapse, 2 near complete remission) who had received 1 (n=9) or 2 (n=7) prior autotransplants.
- Administered nonmyeloablative conditioning with melphalan 100 mg/m² followed by allogeneic stem cell transplantation from HLA-matched (n=14) or mismatched (n=2) sibling donors.
- Infused donor lymphocytes into 14 patients without active graft-versus-host disease to establish full donor chimerism (n=4) or clear residual disease (n=10), following patients for a median of 1 year.
- Achieved myeloid engraftment in 15 of 16 patients, with 12 reaching full donor chimerism by day +21 and a 0% transplant-related mortality rate at day 100.
- Elicited disease responses in 12 patients (5 sustained complete remissions, 3 near complete remissions, and 4 partial remissions), with 3 of 4 progressing patients subsequently responding to chemotherapy and donor lymphocyte infusions.
- Observed acute graft-versus-host disease in 10 patients (1 fatal grade IV) and chronic graft-versus-host disease in 7 patients, leading to 3 deaths from graft-versus-host complications without active myeloma.
Cite This Study
Badros et al. (2001) studied this question.