Clinical Trial Results Of Myeloablative Allogeneic Transplantation

Results from several large trials of myeloablative allo-geneic SCT in patients with myeloma are available both from cooperative groups and several single institutions (Table 85.1). The EBMTR has reported the results of 162 patients receiving allogeneic Stem cell transplant for multiple myeloma at over 40 centers in Europe and South Africa.1318 23 The median age was 43 years, and 52% of the patients had evidence of chemotherapy-sensitive disease at the time of transplant. Although the ablative regimens differed between centers, the majority (72%) of patients received highdose chemotherapy, most commonly cyclophos-phamide and melphalan, combined with total body irradiation (TBI). Graft-versus-host disease (GvHD) prophylaxis also varied by center. Cyclosporine was combined either with methotrexate (48%) or with other agents (20%). T-cell depletion, either alone or in combination with other agents, was used in 33% of patients. The overall treatment-related mortality (TRM) was 25%, with most patients succumbing to complications of infection, interstitial pneumonitis, or GvHD. The overall CR rate was 44%, and the overall actuarial survival rates at 4 years and 9 years after were 32 and 18%, respectively. Relapse-free survival was 34% at 6 years for those patients who attained a CR after transplant.

Similar results have been reported from several large single institutions. In the FHCRC experience, 80 patients underwent myeloablative allogeneic

Table 85.1 Results of allogeneic transplantation in multiple myeloma
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