Impact of high-risk cytogenetics and achievement of molecular remission on long-term freedom from disease after autologous-allogeneic tandem transplantation in patients with multiple myeloma
Nicolaus Kröger, Anita Badbaran, Tatjana Zabelina, Francis Ayuk, Christine Wolschke, Haefaa Alchalby, Evgeny Klyuchnikov, Djordje Atanackovic, Georgia Schilling, Timon Hansen, Sabine Schwarz, Marion Heinzelmann, Silke Zeschke, Ulrike Bacher, Thomas Stübig, Boris Fehse, Axel R Zander, Nicolaus Kröger, Anita Badbaran, Tatjana Zabelina, Francis Ayuk, Christine Wolschke, Haefaa Alchalby, Evgeny Klyuchnikov, Djordje Atanackovic, Georgia Schilling, Timon Hansen, Sabine Schwarz, Marion Heinzelmann, Silke Zeschke, Ulrike Bacher, Thomas Stübig, Boris Fehse, Axel R Zander
Abstract
Within a prospective protocol, the incidence and impact of achievement of molecular remission (mCR) and high-risk cytogenetics was investigated in 73 patients with multiple myeloma (MM) after autologous (auto)-allogeneic (allo) tandem stem cell transplantation (SCT). After induction chemotherapy, patients received melphalan 200 mg/m(2) before undergoing auto-SCT, followed 3 months later by melphalan 140 mg/m(2) and fludarabine 180 mg/m(2) before allo-SCT. Sixteen patients had high-risk cytogenetic features, defined by positive FISH for del(17p13) and/or t(4;14). Overall, 66% of the patients achieved CR or near-CR, and 41% achieved mCR, which was sustained negative (at least 4 consecutive samples negative) in 15 patients (21%), with no significant difference in incidence between the patients with high-risk cytogenetics and others (P = .70). After a median follow-up of 6 years, overall 5-year progression-free survival was 29%, with no significant difference between del 17p13/t(4;14)-harboring patients and others (24% versus 30%; P = .70). The 5-year progression-free survival differed substantially according to the achieved remission: 17% for partial remission, 41% for CR, 57% for mCR, and 85% for sustained mCR. These results suggest that auto-allo tandem SCT may overcome the negative prognostic effect of del(17p13) and/or t(4;14) and that achievement of molecular remission resulted in long-term freedom from disease.
Trial registration: ClinicalTrials.gov NCT00781170.
Copyright © 2013. Published by Elsevier Inc.
Source: PubMed