Trends in allogeneic stem cell transplantation for multiple myeloma: a Center for International Blood and Marrow Transplant Research (CIBMTR) analysis
A partir des données de 3 cohortes (343, 376 et 488 participants), cette étude américaine évalue l’évolution du recours à une greffe allogénique de cellules souches pour les patients atteints de myélome multiple
Allogeneic hematopoietic cell transplantation (allo-HCT) in multiple myeloma (MM) is limited by prior reports of high treatment-related mortality (TRM). We analyzed outcomes after allo-HCT for MM in 1207 recipients in 3 cohorts based on the year of transplantation: 1989-94 (n=343), 1995-2000 (n=376), and 2001-05 (n=488). The most recent cohort was significantly older (53% over 50 years) and had more recipients after prior autotransplant. Use of unrelated donors, reduced-intensity conditioning and the blood cell grafts increased over time. Rates of acute graft-versus-host-disease (GvHD) were similar, but chronic GvHD rates were highest in the most recent cohort. Overall survival (OS) at 1-year increased over time, reflecting a decrease in TRM, but 5-year relapse rates increased from 39% (95% CI, 33-44%) in 1989-94 to 58% (95% CI, 51-64%; p<0.001) in the 2001-05 cohort. Projected 5-yr PFS and OS are 14% (95% CI 9-20%) and 29% (95% CI 23-35%), respectively in the latest cohort. Increasing age, longer interval from diagnosis to transplant and unrelated donor grafts adversely impacted OS in multivariate analysis. Survival at 5 years for subjects with none, 1, 2 or 3 of these risk factors were 41% (36-47), 32% (27-37), 25% (19-31) and 3% (0-11), respectively (p<0.0001).
Blood 2011