Myeloablative Allogeneic Stem Cell Transplant

Allogeneic hematopoietic stem cell transplantation is the only therapy that has the potential to be curative in MMM (see Table 49.1). Guardiola and colleagues26 performed myeloablative allogeneic transplants in 55 MMM patients (median age 42). The 5-year survival was approximately 50%, with a 27% 1-year transplant-related mortality and 33% experiencing grade III-IV acute graft-versus-host disease (GvHD). Subsequent trials have confirmed the potential for long-term complete response with allogeneic stem cell transplant, but at the cost of significant short-and long-term risk, particularly in older patients (see Table 49.1).

Deeg and colleagues23 reported data on 56 patients with MMM receiving allogeneic stem cell transplantation (with a range of mainly busulfan-based conditioning regimens) and showed a 3-year survival of 58% (highest with "targeted" busulfan conditioning). Several patients demonstrated sustained absence of obvious features of diseases (splenomegaly or intramedullary fibrosis). Nonrelapse mortality was 18/56 (32%), with 68 and 59% incidences of acute (grades II—IV) and chronic GvHD (extensive in 90% of those afflicted), respectively. Posttransplant mortality was highest in those with poor Lille prognosis,13 karyotypic abnormalities, and severe marrow fibrosis.

0 0

Post a comment