Nonmyeloablative Stem Cell Transplantation For Myeloma

Nonmyeloablative stem cell transplantation (NST) has been explored as an alternative to myeloablative transplantation for patients with myeloma. A variety of conditioning regimens and GvHD prophylactic regimens have been employed54-58 (Table 85.3). Several of these studies have combined an autologous transplant procedure with a nonmyeloablative transplantation in order to achieve better disease control and greater host immune suppression prior to proceeding to nonmye-loablative transplantation. Overall, these studies report TRM at 100 days ranging from 0 to 19% and event-free survival rates at 2 years ranging from 19 to 55%. While initial results are encouraging, data are not yet available on the durability of these responses. Early attempts to reduce GvHD complications after non-myeloablative transplantation using a T-cell depletion followed by DLI approach have not been encourag-

ing.59

Prognostic features associated with an improved outcome after nonmyeloablative transplantation include chemotherapy-sensitive disease, good performance status, complete remission after transplantation, and evidence of chronic GvHD.60 Patients with deletions of 13q were at increased risk of relapse after NST, compared with patients without this abnormality.61 These results demonstrate that induction of the GvM effect may lead to significant remissions in patients with myeloma. Identifying the targets of the GvM reaction may help make this therapy more efficacious and specific.

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