Multiple myeloma

We recently reported results in 54 multiple myeloma patients who first received a cytoreductive autologous HCT followed by a planned nonmyeloablative HCT.64 Patients were 29-71 (median 52) years old and had previously treated stage II or III multiple myeloma. Forty-eight percent had refractory (35%) or relapsed (13%) disease. Conditioning regimens for autologous and nonmyeloablative transplants were melphalan 200 mg/m2 and 2 Gy TBI, respectively. Nonmyeloablative HCT was performed 40-229 (median 62) days after the autologous transplant. The 100-day mortalities after autologous and allogeneic HCT were 2 and 2%, respectively. With a median follow-up of 552 days after allografting, 57% of patients achieved complete remissions and 26% partial remissions. Of the 28 patients with responsive disease entering the trial (complete/partial remissions), 3 have died and 2 have had disease progression. In contrast, of the 26 patients with relapsed or refractory disease at study entry, 9 have died. Causes of death in both groups were complications related to GvHD (n = 4), progression (n = 3), pulmonary failure (n = 2), lung cancer (n = 1), CMV infection (n = 1), and encephalopathy (n = 1). The estimated 2-year overall and progression-free survivals were 78 and 55%, respectively.

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