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| Unrelated stem cell transplantation in multiple myeloma after a reduced-intensity conditioning with pretransplantation antithymocyte globulin is highly effective with low transplantation-related mortality |
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| Author(s): Kroger N, Sayer HG, Schwerdtfeger R, Kiehl M, Nagler A, Renges H, Zabelina T, Fehse B, Ayuk F, Wittkowsky G, Schmitz N, Zander AR |
| Source: BLOOD Volume: 100 Issue: 12 Pages: 3919-3924 Published: DEC 1 2002 |
| Times Cited: 93 References: 33 |
| Abstract: We investigated the feasibility of unrelated stem cell transplantation in 21 patients with advanced stage II/III multiple myeloma after a reduced-intensity conditioning regimen, consisting of fludarabine (150 mg/m(2)), melphalan (100-140 mg/m(2)), and antithymocyte globulin (ATG; 10 mg/kg on 3 days). The median patient age was 50 years (range, 32-61. years). All patients had received at least one prior autologous transplantation, in 9 cases as part of an autologous-allogeneic tandem protocol. No graft failure was observed. At day 40 complete donor chimerism was detected in all patients. Grade II to IV acute graft-versus-host disease (GVHD) was seen in 8 patients (38%), and severe grade III/IV GVHD was observed in 4 patients (19%). Six patients (37%) developed chronic GVHD, but only 2 patients (12%) experienced extensive chronic GVHD. The estimated probability of nonrelapse mortality at day 100 was 10% and at 1 year was 26%. After allografting, 40% of the: patients achieved a complete remission; and 50% achieved a partial remission, resulting in an overall response rate of 90%. After a median follow-up of 13 months, the 2-year estimated overall and progression-free survival rates are 74% (95% CI, 54%-94%) and 53% (95% CI, 29%-87%), respectively. A shorter progression-free survival was seen in patients who already experienced relapse to prior autograft (26% versus 86%, P =.04). Dose-reduced conditioning with pretransplantation ATG followed by unrelated stem cell transplantation provides durable engraftment and donor chimerism, reduces substantially the risk of transplant-related organ toxicity, and induces high remission rates. (C) 2002 by The American Society of Hematology. |
| Document Type: Article |
| Language: English |
| Reprint Address: Kroger, N (reprint author), Univ Hamburg, Hosp Eppendorf, Dept Bone Marrow Transplantat, Martinistr 52, D-20246 Hamburg, Germany |
Addresses:
1. Univ Hamburg, Hosp Eppendorf, Dept Bone Marrow Transplantat, D-20246 Hamburg, Germany
2. Allgemein Krankenhaus St Georg, Dept Hematol, Hamburg, Germany
3. Univ Jena, Dept Hematol & Oncol, D-6900 Jena, Germany
4. DKD Clin, Dept Bone Marrow Transplantat, Wiesbaden, Germany
5. Bone Marrow Transplantat Clin, Idar Oberstein, Germany
6. Chaim Sheba Med Ctr, IL-52621 Tel Hashomer, Israel |
| Publisher: AMER SOC HEMATOLOGY, 1900 M STREET. NW SUITE 200, WASHINGTON, DC 20036 USA |
| Subject Category: Hematology |
| IDS Number: 619BP |
| ISSN: 0006-4971 |
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