Allogeneic hematopoietic cell transplant (HCT) may improve long-term multiple myeloma (MM) control through the graft-versus-myeloma effect. The Blood and Marrow Transplant Clinical Trials Network 0102 trial was a biologic assignment trial comparing tandem autologous transplant (auto-auto) versus autologous followed by reduced-intensity allogeneic (auto-allo) transplant in patients with newly diagnosed MM with standard-risk (n = 625) or high-risk (n = 85; β2-microglobulin at diagnosis ≥ 4 mg/dL or deletion of chromosome 13 by conventional karyotyping) disease. Although the initial 3-year analysis showed no difference in progression-free survival (PFS) between arms in either risk group, we hypothesized that long-term follow-up may better capture the impact of the graft-versus-myeloma effect. Median follow-up of survivors was over 10 years. Among standard-risk patients there was no difference in PFS (hazard ratio [HR], 1.11; 95% confidence interval [CI],. 93 to 1.35; P = .25) or OS (HR, 1.03; 95% CI,. 82 to 1.28; P = .82). The 6-year PFS was 25% in the auto-auto arm versus 22% in the auto-allo arm (P = .32), and 6-year overall survival (OS) was 60% and 59%, respectively (P = .85). In the high-risk group, although there was no statistically significant difference in PFS (HR,. 66; 95% CI,. 41 to 1.07; P = .07) and OS (HR, 1.01; 95% CI,. 60 to 1.71; P = .96), a reduction in 6-year risk of relapse of 77% versus 47% (P = .005) was reflected in better PFS of 13% versus 31% (P = .05) but similar OS, at 47% versus 51% (P = .69). Allogeneic HCT can lead to long-term disease control in patients with high-risk MM and needs to be explored in the context of modern therapy.
Bibliographical noteFunding Information:
Financial disclosure: Support for this study was provided to the BMT CTN by grant U01HL069294 from the National Heart, Lung, and Blood Institute and the National Cancer Institute, along with funding from the Southwest Oncology Group (grant U10CA180888). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Southwest Oncology Group. The Clinicaltrials.gov identifier is NCT00075829. Conflict of interest statement : There are no conflicts of interest to report. Authorship statement : S.G., L.J.C., M.P., and E.S. contributed equally to this work.
© 2019 American Society for Transplantation and Cellular Therapy
- Multiple myeloma
PubMed: MeSH publication types
- Journal Article
- Research Support, N.I.H., Extramural