[Show abstract][Hide abstract]ABSTRACT: We have conducted a study of patients with multiple myeloma (MM) undergoing allogeneic transplantation to evaluate outcome parameters.
Fifty seven consecutive patients with MM received an allogeneic transplantation between 2004 and 2011 at our institution. Patients who had received at least one prior autologous transplant were included. Twenty six patients underwent allogeneic transplantation for consolidation after a response to their first autograft, and 30 patients received an allogeneic transplantation as salvage therapy. Donor source was evenly distributed between related and unrelated.
The median follow-up was 52 months. Thirty two (57.1%) patients achieved a CR. At 5 years, 49.2% of all patients were in CR. Sixteen patients received either donor lymphocyte infusions (DLI) or immune suppression withdrawal for disease progression, with a 62.5% response rate. The 5-year OS for all patients was 59%. The 5-year OS for the 30 patients in the consolidation group was 82% compared to 38% for the salvage group. In multivariate analysis, 3 factors remained significantly associated with OS. These include being in the salvage group (HR 4.05, p=0.0196), acute graft-versus-host disease (HR 2.99, p=0.034) and chronic graft-versus-host disease (cGVHD) which was highly protective, with a 5-year OS of 78.8% for patients with cGVHD versus 42.6% for patients without cGVHD (HR 0.17, p=0.008).
Our data show that allogeneic transplantation for multiple myeloma can lead to sustained remissions. Acute GVHD (aGVHD) is significantly deleterious to OS and PFS, whereas cGVHD is strongly favorable, supporting an important role for the graft-versus-myeloma effect.
Preview · Article · Apr 2014 · Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation
[Show abstract][Hide abstract]ABSTRACT: Chronic graft-versus-host disease (GVHD) is an immune-mediated disorder that adversely affects quality of life and clinical outcomes in patients following hematopoietic stem cell transplantation. Conventional treatment of GVHD includes prolonged and high-dose corticosteroids; however, those drugs are associated with multiple side effects. This article describes the ability of extracorporeal photopheresis therapy to exhibit a steroid-sparing effect, which can reduce long-term complications as a consequence of steroid treatment.
Preview · Article · Aug 2011 · Clinical Journal of Oncology Nursing