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Sydney 2005: Strategies to Improve the Graft v MM Effect of Allo SCT & Donor Lymphocyte Infusions
By Henk Lokhorst, MD
Dr. Lokhorst talked about strategies to improve graft versus myeloma (GvM) and discussed what can be learned from DLI. Donor T cells are essential for GvM and induction of chronic GVHD is critical for GVM. DLI following non-myeloablative allo-sct showed a 38% response. While the duration of response was short in for patients achieving PR (8 mo), those achieving CR had 30 months duration of response. OS is at least 1 year and has not yet been achieved. Toxicity was of this treatment regimen is low, with 10% TRM, 25% acute GVHD, 43% chronic GVHD. Dr. Lokhorst then discussed the efficacy of thalidomide treatment after allo-sct. Notably, 60% of patients achieved a PR and 24% a very good PR. The duration of response was more than 12 months. GVHD flare up was seen in only 3 patients. New strategies include application of novel agents after transplantation, eg, thalidomide and Velcade.

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