[Multibilly]

Results of new allo transplant study from Spain

by Multibilly on Tue Jan 27, 2015 9:22 pm

See the abstract below.

I think there is merit to allos for some specific patients, but these quoted TRM (treatment- related mortality rates) were a bit alarming to me.

It could be that these were patients that were already in pretty poor shape before beginning the allo procedure. Also, the study was conducted over 28 years (and allo techniques have improved considerably in the past three decades). And the TRM rates are quoted "at any time", as opposed to for 1, 2 or 3 years post transplant.

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L Rosiñol et al, "Allogeneic hematopoietic SCT in multiple myeloma: long-term results from a single institution," Bone Marrow Transplantation, January 26 2015 (abstract)

Abstract:

The role of allogeneic hematopoietic SCT (allo-HCT) in multiple myeloma (multiple myeloma) remains controversial. A total of 58 patients received an allo-HCT (25 of them with myelo­ab­lative conditioning - "allo-MAC" - and 33 with reduced-intensity conditioning - "allo-RIC") at our institution over a 28-year period.

The CR rate for allo-MAC was 36%. The incidence of grade III-IV acute GVHD (aGVHD) and chronic GVHD (cGVHD) was 28% and 39%, respectively. The TRM at any time was 60% and the main causes of death were aGVHD or infectious complications not directly related to GVHD. The estimated PFS and OS at 15 years were 8% and 15%, respectively.

The CR rate with allo-RIC was 45%. The incidence of grade III-IV aGVHD and cGVHD were 24% and 41%, respectively. The TRM at any time was 33% and was mainly related to aGVHD. The estimated PFS and OS at 5 years were 22% and 38%, respectively.

Despite its high TRM, a proportion of patients with high-risk myeloma (early relapse and newly diagnosed ultrahigh risk) may obtain long-term disease control with allo-HCT. New ap­proaches aimed at decreasing the incidence of aGVHD, and consequently to decrease the TRM, are needed.