Comparison Of Myeloablative Allogeneic And Autologous Stem Cell Transplantation

The results of myeloablative allogeneic and autologous transplant for patients with multiple myeloma have

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Figure 85.1 Progression-free survival: comparison of patients receiving either autologous or myeloablative allogeneic transplantation for multiple myeloma been compared.23'24 34-36 The EBMTR performed a retrospective case-matched analysis comparing 189 patients treated with allogeneic transplantation with an equal number of patients undergoing autologous transplant.23 The groups were comparable, except that the median age of patients receiving autologous transplants was 49 years' significantly greater than the median age of 43 years in patients undergoing allo-geneic transplant. The CR rate was similar for both groups; however, the TRM was significantly higher for allogeneic transplant recipients (41% vs 13%). This difference in TRM resulted in a significantly improved median survival for patients treated with autologous transplant (34 months) versus allogeneic transplant (18 months). After 4 years of follow-up, the survival curves for the allogeneic and autologous patient cohorts come together, and thereafter the long-term survival rates in both groups were comparable.

Sixty-two patients receiving a myeloablative allogeneic transplantation were compared with 162 patients receiving autologous transplantation at DFCI.24 The groups were comparable, with the exception that patients receiving autologous transplantation had a higher median age, 50 years versus 45 years; received transplantation earlier after diagnosis; and had received fewer regimens prior to transplantation. Patients receiving autologous transplantation had a superior overall and progression-free survival at 2 years after transplantation, 74 and 48% respectively, compared with patients receiving allogeneic transplantation, 58 and 28%, respectively. By 4 years after transplantation, overall survival and progression-free survival were similar— 41 and 23% for autologous recipients and 39 and 18% for allogeneic transplant recipients, respectively (Figure 85.1). The 4-year cumulative TRM was significantly higher for the allogeneic transplant patients, 24% versus 13% for autologous transplant patients. Relapse of disease was the most common cause of treatment failure for both transplant procedures, but was higher for patients receiving autologous transplantation, 56%, compared with 46% for those receiving allogeneic transplantation (Figure 85.2). Therefore, despite the lower incidence of relapse following allogeneic transplantation, the high TRM following allogeneic transplantation results in an inferior overall survival when compared with autologous transplantation. The lower relapse rate is in part related to the potent GvM effect mediated by the allogeneic immune system. Efforts are

Figure 85.2 Comparison of risk of relapse after myeloablative allogeneic transplantation and autologous transplantation

currently focused on reducing the treatment-related toxicity of transplantation using nonmyeloablative conditioning regimens while preserving the GvM effect.

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