Reduced-Intensity Conditioning Allogeneic Stem Cell Transplantation for Multiple Myeloma: Results from the Japan Myeloma Study Group
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
We conducted a retrospective survey of multiple myeloma (MM) patients who underwent reduced-intensity conditioning allogeneic stem cell transplantation (RIST) at 11 hospitals participating in the Japan Myeloma Study Group. Forty-five patients (median age, 53 years) were included in this study. The conditioning regimen consisted of a fludarabine-based regimen in 24 patients and a regimen based on total body irradiation (1–2 Gy) in 18 patients. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine and tacrolimus in 28 and 17 patients, respectively. All patients showed myeloid engraftment. Complete chimerism was obtained in 42 patients. Grade II to IV acute GVHD developed in 28 (65%) of 43 patients evaluated, and chronic GVHD developed in 31 (76%) of 41 patients. Early death before day 100 was observed in 4 patients (8.8%). A complete response (CR) was obtained in 12 patients. The factors affecting overall survival were severe acute GVHD and the response after RIST. To date, 18 patients are alive, with 9 patients remaining in CR at a median follow-up of 25 months. The overall and progression-free survival rates at 3 years were 38.5% and 18.8%, respectively. These observations suggest that RIST is feasible with reliable donor engraftment and relatively low transplantation-related mortality in Japanese MM patients.
- Attal M, Harousseau JL, Stoppa AM, et al. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma: Intergroupe Francais du Myelome. N Engl J Med. 1996;335:91–97. CrossRef
- Child AJ, Morgan GJ, Davies FE, et al. High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med. 2003;348:1875–1883. CrossRef
- Cavo M, Terragna C, Martinelli G, et al. Molecular monitoring of minimal residual disease in patients in long-term complete remission after allogeneic stem cell transplantation for multiple myeloma. Blood. 2000;96:355–357.
- Martinelli G, Terragna C, Zamagni E, et al. Molecular remission after allogeneic or autologous transplantation of hematopoietic stem cells for multiple myeloma. J Clin Oncol. 2000;18:2273–2281.
- Verdonck LF, Lokhorst HM, Dekker AW, Nieuwenhuis HK, Petersen EJ. Graft-versus-myeloma effect in two cases. Lancet. 1996;347:800–801. CrossRef
- Lokhorst HM, Schattenberg A, Cornelissen JJ, et al. Donor lymphocyte infusions for relapsed multiple myeloma after allogeneic stem-cell transplantation: predictive factors for response and long-term outcome. J Clin Oncol. 2000;18:3031–3037.
- Bensinger W, Buckner CD, Anasetti C, et al. Allogeneic marrow transplantation for multiple myeloma: an analysis of risk factors on outcome. Blood. 1996;88:2787–2793.
- Bjorkstrand BB, Ljungman P, Svensson H, et al. Allogeneic bone marrow transplantation versus autologous stem cell transplantation in multiple myeloma: a retrospective case-matched study from the European Group for Blood and Marrow Transplantation. Blood. 1996;88:4711–4718.
- Gahrton G, Svensson H, Cavo M, et al. Progress in allogeneic bone marrow and peripheral blood stem cell transplantation for multiple myeloma: a comparison between transplants performed 1983–93 and 1994–98 at European Group for Blood and Marrow Transplantation centres. Br J Haematol. 2001;113:209–216. CrossRef
- Slavin S, Nagler A, Naparstek E, et al. Nonmyeloablative stem cell transplantation and cell therapy as an alternative to conventional bone marrow transplantation with lethal cytoreduction for the treatment of malignant and nonmalignant hematologic diseases. Blood. 1998;91:756–763.
- Khouri IF, Keating M, Korbling M, et al. Transplant-lite: induction of graft-versus-malignancy using fludarabine-based nonablative chemotherapy and allogeneic blood progenitor-cell transplantation as treatment for lymphoid malignancies. J Clin Oncol. 1998;16:2817–2824.
- Badros A, Barlogie B, Morris C, et al. High response rate in refractory and poor-risk multiple myeloma after allotransplantation using a nonmyeloablative conditioning regimen and donor lymphocyte infusions. Blood. 2001;97:2574–2579. CrossRef
- Badros A, Barlogie B, Siegel E, et al. Improved outcome of allogeneic transplantation in high-risk multiple myeloma patients after nonmyeloablative conditioning. J Clin Oncol. 2002;20:1295–1303. CrossRef
- Giralt S, Aleman A, Anagnostopoulos A, et al. Fludarabine/melphalan conditioning for allogeneic transplantation in patients with multiple myeloma. Bone Marrow Transplant. 2002;30:367–373. CrossRef
- Kroger N, Schwerdtfeger R, Kiehl M, et al. Autologous stem cell transplantation followed by a dose-reduced allograft induces high complete remission rate in multiple myeloma. Blood. 2002;100:755–760. CrossRef
- Kroger N, Sayer HG, Schwerdtfeger R, et al. Unrelated stem cell transplantation in multiple myeloma after a reduced-intensity conditioning with pretransplantation antithymocyte globulin is highly effective with low transplantation-related mortality. Blood. 2002;100:3919–3924. CrossRef
- Perez-Simon JA, Martino R, Alegre A, et al. Chronic but acute graft-versus-host disease improves outcome in multiple myeloma patients after non-myeloablative allogeneic transplantation. Br J Haematol. 2003;121:104–108. CrossRef
- Einsele H, Schafer H, Hebart H, et al. Follow-up of patients with progressive multiple myeloma undergoing allografts after reduced- intensity conditioning. Br J Haematol. 2003;121:411–418. CrossRef
- Shaw BE, Peggs K, Bird JM, et al. The outcome of unrelated donor stem cell transplantation for patients with multiple myeloma. Br J Haematol. 2003;123:886–895. CrossRef
- Maloney DG, Molina AJ, Sahebi F, et al. Allografting with nonmyeloablative conditioning following cytoreductive autografts for the treatment of patients with multiple myeloma. Blood. 2003;102:3447–3454. CrossRef
- Lee CK, Badros A, Barlogie B, et al. Prognostic factors in allogeneic transplantation for patients with high-risk multiple myeloma after reduced intensity conditioning. Exp Hematol. 2003;31:73–80. CrossRef
- Mohty M, Boiron JM, Damaj G, et al. Graft-versus-myeloma effect following antithymocyte globulin-based reduced intensity conditioning allogeneic stem cell transplantation. Bone Marrow Transplant. 2004;34:77–84. CrossRef
- Blade J, Samson D, Reece D, et al. Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haematopoietic stem cell transplantation. Br J Haematol. 1998;102:1115–1123. CrossRef
- Morishima Y, Morishita Y, Tanimoto M, et al. Low incidence of graft-versus-host disease by the administration of methotrexate and cyclosporine in Japanese leukemia patients after bone marrow transplantation from human leukocyte antigen compatible siblings: possible role of genetic homogeneity. The Nagoya Bone Marrow Transplantation Group. Blood. 1989;74:2252–2256.
- Corradini P, Cavo M, Lokhorst H, et al. Molecular remission after myeloablative allogeneic stem cell transplantation predicts a better relapse-free survival in patients with multiple myeloma. Blood. 2003;102:1927–1929. CrossRef
- Lahuerta JJ, Martinez-Lopez J, Serna JD, et al. Remission status defined by immunofixation vs. electrophoresis after autologous transplantation has a major impact on the outcome of multiple myeloma patients. Br J Haematol. 2000;109:438–446. CrossRef
- Kroger N, Scilling G, Einsele H, et al. Deletion of chromosome band 13q14 as detected by fluorescence in situ hybridization is a prognostic factor in patients with multiple myeloma who are receiving allogeneic dose-reduced stem cell transplantation. Blood. 2004;103:4056–4061. CrossRef
- Kroger N, Perez-Simon FA, Myint H, et al. Relapse to prior autograft and chronic graft-versus-host disease are the strongest prognostic factors for outcome of melphalan/fludarabine-based dose- reduced allogeneic stem cell transplantation in patients with multiple myeloma. Biol Blood Marrow Transplant. 2004;10:698–708. CrossRef
- Facon T, Avet-Loiseau H, Guillerm G, et al. Chromosome 13 abnormalities identified by FISH analysis and serum β2-microglobulin produce a powerful myeloma staging system for patients receiving high-dose therapy. Blood. 2001;97:1566–1571. CrossRef
- Reduced-Intensity Conditioning Allogeneic Stem Cell Transplantation for Multiple Myeloma: Results from the Japan Myeloma Study Group
International Journal of Hematology
Volume 81, Issue 4 , pp 342-348
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Multiple myeloma
- Reduced-intensity conditioning stem cell transplantation (RIST)
- Japan Myeloma Study Group (JMSG)
- Industry Sectors
- Author Affiliations
- 1. Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, 602-8566, Kamigyoku, Kyoto, Japan
- 2. Department of Hematology, Kyoto First Red Cross Hospital, Kyoto
- 3. Department of Medicine, Toyama Prefectural Central Hospital, Toyama
- 4. Department of Medicine, Niigata Cancer Center Hospital, Niigata
- 5. Second Department of Medicine, Chiba University School of Medicine, Chiba
- 6. Fourth Department of Internal Medicine, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima
- 7. Department of Hematology, Saiseikai Maehashi Hospital, Maehashi
- 8. Division of Hematology and Oncology, Chiba Cancer Center Hospital, Chiba
- 9. First Department of Internal Medicine, Sapporo Medical University, Sapporo
- 10. Department of Molecular Genetics and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto
- 11. Department of Hematology and Collagen Disease, Nagoya City University Hospital, Nagoya
- 12. Japan Myeloma Study Group, Japan