This session deat with the role of reduced-dose allogeneic transplantation ("mini allos"). Discussions in this session were quite heated. Most groups feel that full allogeneic transplantation is rarely recommended because of high toxicities, "mini allos" are an interesting new approach, but still with significant toxicities, particularly chronic graft versus host disease. Caonerns were expressed that the relatively early pattern of relapses with "mini allos" indicates that the desired complete remissions are not being achieved. Further studies are required to address these issues.
Dose Reduced Intensity Regimens: The Seattle Experience: Dr. William Bensinger
Dr. Bensinger presented the results of the Seattle tandem autologous / non-ablative allogeneiec stem cell transplantation.
54 patients were treated.
The rate of chronic graft versus host disease was 58%.
Good response rates (>50% CRs) were achieved, with many CRs achieved only post-allo.
With median follow up now at 22 months, overall survial data is encouraging, though there have been a significant number of relapses.
Full allogeneic tranplants had higher transplant related mortality (22%).
Dr, Bensinger also reported on "mini allos" performed with matched unrelated donors, with 10 of 16 patients alive, with 8 in either partial or complete remission, with 3-24 months follow-up.
Dose Reduced Intensity Regimens: The M.D. Anderson Experience: Dr. S. Giralt
Dr. Giralt presented the results of the M.D. Anderson Cancer Center tandem autologous / non-ablative allogeneiec stem cell transplantation.
Dr. Giralt presented a retrospective analysis of the M.D. Anderson's experience with non-myeloablative allo transplants.
The patient population was heavily pre-treated.
There were both sibling and matched unrelated donors, with a mix of fludarabine/melphalan (FM) and melphalan/TBI regimens used.
Event-free survival was predicted by response to the transplant.
The new International Prognostic Index was predictive of overall survival..
Overall survival versus auto transplant for relapsed refractory patients were comparable..
Dose Reduced Intensity Regimens: The Arkansas Experience: Dr. Bart Barlogie
Dr. Barlogie reported on the Little Rock experience with mini-allo's. He began by reporting on the poor outcomes for the allotransplant arm of the intergroup transplant trial, which was shut down due to high mortality rates.
The patient population was heavily pre-treated.with a high percentage of resistant disease.
Dr. Barlogie reported on 55 patients, 44 treated with melphalan 100 with sibling donors, the remainder with Fludarabine + Melphalan 100 with matched unrelated donors.
In patients with CA 13 / hypodiploidy, 3 year survival estimates were 75% for the allo group versus 56% for the tandem auto group.
Survival was consistently better for mini-allo patients versus standard myeloablative allo patients.
Dose Reduced Intensity Regimens: The German Experience: Dr. Nicolaus Kröger
Dr. Kröger presented the results of an international joint-study.
The trial looked at rediced intensity allografts with both related and unrelated donors.
Transplant related mortality at one year was 19%.
Seven unfavorable factors for 2 year overall survival were identified.
...and six unfavorable factors for 2 year progression-free survival.
Multivariate analysis identified predictors of both overall survival and progression-free survival.
Relapse after autologous transplant was a strong predictor of poor progression free survival.
Five factors were deemed significant predictors of relapse.
Relapse after autotransplant also predicted early relapse after allo.
Dose Reduced Intensity Regimens: Report From The EBMT: Dr. C. Crawley
Dr. Crawley reported on the EBMT experience with reduced intensity conditioning allogeneic transplantation in myeloma.
26% of the patients achieved a complete remission by day 100.
25% of the patients had extensive GVHD while another 27% had limited GVHD.
Three factors were associated with higher mortality rates.
2 year overall survival was 52%; 2 year progression free survival was 34%.
Complete remission post transplant was associated with higher 2 year overall survival.
GVHD was associated with longer progression-free survival.
...and longer overall survival.
The panel (below) fielded questions at the end of the session. It was observed that with the high rate of chronic graft verus host disease and the number of relapses observed, more trials are necessary to establish role of mini-allos verus autografts and traditional allos.
Please note that the Unknown Patient is a patient, not a doctor and not a scientist. This summary represents a layman's view of what was said at the conference and should form a basis for raising awareness of issues that could be discussed with a qualified professional. In no way should anything contained in this report be taken as medical advice or form the basis for action without first consulting a qualified medical professional who is familiar with your specific medical situation.