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Late relapses following reduced intensity allogeneic transplantation in patients with multiple myeloma: a long‐term follow‐up study
Author(s) -
Sahebi Firoozeh,
Shen Yan,
Thomas Sandra H.,
Rincon Amalia,
MurataCollins Joyce,
Palmer Joycelynne,
Krishnan Amrita Y.,
Karanes Chatchada,
Htut Myo,
Somlo George,
Forman Stephen J.
Publication year - 2013
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.12123
Subject(s) - melphalan , medicine , multiple myeloma , fludarabine , transplantation , regimen , total body irradiation , proportional hazards model , surgery , hematopoietic stem cell transplantation , graft versus host disease , oncology , gastroenterology , chemotherapy , cyclophosphamide
Summary We analysed the long‐term outcomes of 60 multiple myeloma patients who underwent reduced intensity allogeneic stem cell transplantation between A ugust 2000 and M arch 2008. Regimens included fludarabine and melphalan conditioning (flu‐mel regimen) for allogeneic haematopoietic cell transplant ( HCT ) or a planned tandem regimen consisting of high‐dose melphalan conditioning for autograft followed by low‐dose total body irradiation conditioning for allogeneic HCT (auto‐allo regimen). Donors included human‐leucocyte‐antigen‐matched siblings ( n = 55) or matched unrelated donors ( n = 5). With a median follow‐up of 9·8 years, 7‐year overall survival ( OS ) and progression‐free survival ( PFS ) were 60% and 31%, respectively. By multivariate C ox regression analysis, disease status of complete response ( CR ) or partial response ( PR ) at transplant and the presence of chronic graft‐ versus ‐host disease were significantly associated with improved OS . Only disease status was significantly associated with improved PFS . We noted a surprising number of very late relapses, with six patients (10%) relapsing between 6 and 12 years post‐transplant. Among the six late relapse patients, all were transplanted within 14 months of diagnosis, five had normal karyotypes, and five were in CR / PR . Our data provide additional evidence that, while survival may be extended by reduced intensity allogeneic transplant, ultimately, it may not offer a cure.