Prognostic Factors And Outcome After Myeloablative Allogeneic Transplantation

Prognostic factors influencing outcome have been analyzed in patients with multiple myeloma receiving allogeneic SCT. The EBMTR analysis demonstrated improved survival associated with female gender (41% at 4 years), stage I disease at diagnosis (52% at 4 years), treatment with one regimen prior to ablative therapy (42% at 4 years), and achieving CR prior to SCT (64% at 3 years).13'14'23 IgA subtype and a low serum p2-microglobulin also conferred a favorable prognosis. Ability to achieve a CR following transplantation was the most favorable prognostic factor associated with prolonged survival.

In 80 patients receiving transplantation at FHCRC, time from diagnosis to transplant was found to be a significant prognostic factor.20 Patients undergoing transplant more than 1-3 years after diagnosis had a 2.5 times greater 100-day mortality, compared with patients transplanted in the first year after diagnosis. Patients receiving transplantation beyond the first year after diagnosis or those with Durie-Salmon stage III disease had a 1.8 and 2.0 times greater risk of dying from any cause, respectively. Adverse factors predicting relapse or disease progression included female patients receiving marrow grafts from male donors, as well as extensive chemotherapy (greater than eight cycles) prior to transplant. Only Durie-Salmon stage at the time of transplant influenced relapse or progression-free survival, with stage III patients at increased risk, compared with stage I or stage II patients.

Analyzing the outcome of 62 patients undergoing allogeneic transplantation at DFCI, advanced disease was the factor associated with inferior progression-free survival and overall survival. Other factors, such as age less than 40, donor/patient sex, Ig isotype, or time from diagnosis to transplant, were not found to be significant.24

These analyses demonstrate that advanced-stage disease is associated with inferior outcomes after transplant. Data from FHCRC suggest that transplant is more successful if performed early after diagnosis and prior to extensive therapy. Unfortunately, the TRM associated with myeloablative allogeneic transplantation at present is high in patients with myeloma, and use of this modality in patients earlier in their disease course must, therefore, be considered carefully.

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