Haematologica 2003 - Supplements

306
Outcomes in patients with refractory relapse multiple
myeloma after reduced intensity conditioning regimen
allograft or myeloablative autologous stem cell
transplantation.
Antonio Carrasco MD, Ana Aleman MD, Marcos de Lima
MD, Armand Glassman MD, Rima Saliba PhD, Athanassios
Anagnostopoulos MD, Richard Champlin MD and Sergio
Giralt MD.
Department of Blood and Bone Marrow Transplantation1 and the
Department of Hematopathology (AG) of the University of Texas
M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston TX,
77030
Introduction: Stem cell transplantation (SCT) has been shown to
improve survival in patients with multiple myeloma (MM).
Patients with refractory relapse (RR) MM have a poor prognosis
with standard conditioning allografts due to high transplant
related mortality. Myeloablative autologous SCT (ASCT) and
reduced intensity conditioning allografts (RIC) have been
explored in this heavily treated group to improve survival. To
determine the feasibility and efficacy of ASCT and RIC we
retrospectively evaluated our experience in 51 RR MM patients.
Patients and Methods: From 12/89 to 8/02, twenty-nine patients
received ASCT and twenty-two received RIC at the University of
Texas MD Anderson Cancer Center. Among ASCT and RIC,
median age was 53 years (range 31-70) and 51 years (range 46-
65); median time to transplant since diagnostic was 26 months
(range 5-104) and 33 months (range 12-135); median number of
previous treatments was 4 (range 2-9) and 5 (2-9) respectively.
In the RIC group 17 patients (77%) had failed prior autograft.
Among ASCT and RIC, median beta 2 microglobulin prior to
SCT was 3.4 mg/dl (range 1.3-20.3) and 5.0 mg/dl (2.3-5.8)
respectively. Cytogenetics studies prior to SCT were performed
in 73% (37/51) of the patients: 46% (17/37) were diploid and
54% (20/37) showed random and complex karyotypes, mostly
involving chromosomes 11 and 13. For ASCT, 52% received
Thiothepa/Busulfan/ Cyclophosphamide (Cy) as conditioning;
38% Melphalan (Mel) 200 mg/mt2 and 10% Cy/Topotecan/Mel.
For RIC, 81% received Fludarabine (F) 30 mg/mt2 for 4 days
with Mel 140 mg/mt2 as conditioning; 9% F/Mel 180 mg/mt2
and 10% F/Mel 100 mg/mt2 or Cy/F.
Results: Forty-eight patients achieved absolute neutrophils counts
(ANC) ≥ 0.5*109 /lt, one RIC and 2 ASCT failed to recover.
Median time for ANC recovery was 12 days (range 8-24) and 10
days (range 8-24) for RIC and ASCT respectively. Early death
( 1 year. Long-term disease control was
only achieved in patients with chemosensitive disease before
allografting. Estimated 2 years overall and event-free survival
was respectively 25.5% and 22.0% for the whole patient group,
and 62.5% and 57.1% for patients with chemosensitive disease.
Chemorefractory disease prior to allogeneic stem cell
transplantation (p=0.0182) and absence of cGvHD (p=0.069)
were associated with shorter event-free survival. Thus long-term
disease control can be achieved, but is restricted to patients
responding to prior salvage chemotherapy.
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