Allogeneic Transplantation in
Multiple Myeloma ­ State of the Art
Sydney April 13 2005
Allogeneic transplantation in Multiple Myeloma
Survival, BM
1.0
p<0.0001
Tx 94-98
S
0.8
n=223
u
r
0.6
v
0.4
i
v
Tx 83-93
0.2
a
n=334
l
0.0
Months
0
24
48
72
96
120
144
At risk: 83-93
157
108
65
32
12
2
94-98
100
28
0
EBMT 2005
Allogeneic transplantation in Multiple Myeloma
PBSCT versus BMT
Survival
1.0
S
p=0.05
u
0.8
r
BM n=297
0.6
v
i
0.4
v
PBSC n=224
a
0.2
l
0.0
Months
0
12
24
36
48
60
72
84
96
At risk: BM
145
98
66
36
10
1
PBSC
74
25
5
EBMT 2005
Molecular remission after myeloablative allogeneic transplantation
predicts a better relapse-free survival in multiple myeloma
Cumulative relapse risk
according to molecular status
100
Negative
iskr
80
Positive
pse
Mixed
lae ) 60
r
(%
tive
40
laum 20
uC
0
0
25
50
75
100
125
150
Months
The cumulative risk of relapse at 5 years for NEG, MIX and POS patients
was 0%, 33% and 100%, respectively
EBMT 2005
Corradini et al. Blood, 2003
Multiple Myeloma
Relapse/Progression - Donor Gender Study
1.0
.8
.6
M:F
F:F
.4
M:M
F:M
.2
0.0
0
24
48
72
96
120
time (months)
M:M
476
116
54
28
14
7
F:M
334
71
21
10
5
0
M:F
258
63
23
10
6
4
F:F
244
82
45
19
10
5
EBMT 2005
Population at risk
Multiple Myeloma
Non-Relapse Mortality - Donor Gender study
1.0
.8
.6
F:M
M:F
.4
M:M
F:F
.2
0.0
0
24
48
72
96
120
time (months)
M:M
476
116
54
28
14
7
F:M
334
71
21
10
5
0
M:F
258
63
23
10
6
4
F:F
244
82
45
19
10
5
EBMT 2005
Population at risk
Multiple Myeloma - Donod Gender Study
Male patients - Overall survival
1.0
.8
.6
Male Donor, >=1994
Female Donor, >=1994
.4
Male Donor, <1994
Female Donor, <1994
.2
0.0
0
6
12
18
24
time (months)
M Dnr, <1994
119
70
57
55
50
F Dnr, <1994
72
31
25
22
22
M Dnr >=1994
357
232
177
128
112
F Dnr, >=1994
262
155
116
83
69
EBMT 2005
Population at risk
Allogeneic transplantation in Multiple Myeloma
Standard myeloablative conditioning
Summary
· Improvement in overall survival and transplant related
mortality since 1994
· PBSCT not superior to BMT
· Molecular remission predicts better outcome
· Males with female donor have lowest relapse rate, offsetting
higher TRM and resulting in OS similar to
transplants with male donor since 1994
· Females with female donor have best outcome
· Other favorable prognostic factors are stage I at
diagnosis, only one line of chemotherapy before
transplantation and response to previous treatment
EBMT 2005
Multiple myeloma
Allogeneic transplantation ­ Reduced conditioning (RIC)
Summary RIC versus Standard allotransplants
Registry study
·TRM is lower with RIC than with standard conditioning
· Relapse rate is higher with RIC
· Overall survival is similar for RIC and Standard
· RIC has improved since the year 2000
·RIC versus autologous in progress in EBMT registry
· Prospective comparison RIC versus Auto - closed for entry
EBMT 2005
Reduced conditioning Allogeneic Transplantation
versus Autologous Transplantation in Multiple Myeloma
Summary NMAM 2000
· Reduced intensity conditioning allogeneic
transplantation following autologous
transplantation is feasible
· Early transplant related mortality appears
lower ( 11%) than with allogeneic
myeloablative standard conditioning
· Late transplant related mortality and relapse
rate is not yet known
· First analyses expected within 2 years
EBMT 2005
Acknowledgements
Alegre A. (Madrid)
Greinix H. (Vienna)
Apperley J.(London)
Iacobelli S ( Leiden )
Bacigalupo A. (Genoa)
Kröger N ( Hamburg)
Bakkus M.(Brussels)
Kanz L. (Tubingen)
Bjorkstrand B.(Huddinge)
Lalancette M. (London)
Bladé J. (Barcelona)
Leitner G. (Vienna)
Bouko Y. (Brussels)
Ljungman P. (Huddinge)
Boiron JM.(Bordeaux)
Michallet M. (Lyon)
Bourhis J-H (Villejuif)
Morris C ( Belfast )
Brand R ( Leiden )
Nedellec G. (Clamart)
Browne ( Dublin )
Niederw
Niederwieser
eser D. (Leipzig)
Brugger (Tubingen)
Powles R. (London)
Cavo M. (Bologna)
Russell N. (Nottingham)
Coiffier B. (Lyon)
Salles G. (Lyon)
Cornelissen J.J (Rottercam)
Samson D. (London)
Corradini P. (Milano)
Schaefer U.W. (Essen)
Crawley C. (Oxford)
Schattenberg A. (Nijmegen)
de Laurenzi A. (Rome)
Skotnicki ( Krakow )
Derigs G. (Mainz)
Tichelli (Basel)
Facon T. (Lille)
Tura S. (Bologna)
Feremans W. (Brussels)
Verdonck L.F (Utrecht)
ht)
Fernandez M. (Madrid)
Vernant J.P (Paris)
Ferrant A. (Brussels)
Wandt H. (Nurenberg)
Gahrton G. (Huddinge)
Willemze R. (Leiden)
Garcia Conde (Valencia)
EBMT 2005
Volin L. (Helsinki)
Goldschmidt H. (Heidel
(Heidelber
b
g)
erg)

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