A recent article in the journal Blood reported on the long-term outcome of multiple myeloma patients each treated with two stem cell transplants.

In this study, 102 patients with multiple myeloma began treatment with high-dose melphalan (Alkeran) as a conditioning regimen. Patients then received an autologous stem cell transplant, using stem cells collected from the patient before chemotherapy. This was followed by radiation therapy.

Finally, patients received high-dose chemotherapy in combination with an allogeneic stem cell transplant, in which stem cells collected from another individual were placed into the patient’s body after chemotherapy.

The median follow-up time in the study was 6.3 years. Among 95 patients with detectable disease, 59 achieved complete remission. The median time to disease progression after the allogeneic transplant was five years.

The median progression-free survival (PFS), which includes mortality due to any cause, was four years. Five-year overall survival (OS) and PFS were 64 percent and 36 percent, respectively. The 73 patients who received the autologous stem cell transplant within 10 months from treatment initiation had slightly higher five-year OS and PFS of 69 percent and 37 percent, respectively.

At five years, mortality not related to relapse was 18 percent, 95 percent of which was related to infections or graft-versus-host disease (GVHD), when cells from the donor attack a patient’s healthy tissue. Forty-two percent of all patients developed grade 2 (moderate) to 4 (life-threatening) acute GHVD, and 74 percent developed extensive chronic GHVD.

Common side effects of treatment included mucositis (inflammation of the digestive tract lining), nausea, vomiting, diarrhea, and infection.

The researchers concluded that this combination auto/allo stem cell transplant procedure is a viable treament option for patients with advanced multiple myeloma. Nonetheless, long-term disease control and GVHD remain key concerns.

See the article in the journal Blood for further details.