Long-term follow-up of a comparison of nonmyeloablative allografting with autografting for newly diagnosed myeloma

Long-term follow-up of a comparison of nonmyeloablative allografting with autografting for newly diagnosed myeloma
Luisa Giaccone1, Barry Storer2, Francesca Patriarca3, Marcello Rotta2, Roberto Sorasio4, Bernardino Allione5, Fabrizio Carnevale-Schianca6, Moreno Festuccia1, Lucia Brunello1, Paola Omedè1, Sara Bringhen1, Massimo Aglietta6, Alessandro Levis5, Nicola Mordini4, Andrea Gallamini4, Renato Fanin3, Massimo Massaia1, Antonio Palumbo1, Giovannino Ciccone7, Rainer Storb2, Ted A. Gooley2, Mario Boccadoro1, and Benedetto Bruno1

+ Author Affiliations

1Division of Hematology, San Giovanni Battista Hospital, University of Torino, Torino, Italy;
2Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA;
3Division of Hematology, Department of Clinical and Morphological Researches, University of Udine, Udine, Italy;
4Division of Hematology at the Santa Croce e Carle Hospital, Cuneo, Italy;
5Division of Hematology, Sant'Antonio e Biagio Hospital, Alessandria, Italy;
6Division of Oncology, IRCC, Candiolo, Italy; and
7Unit of Cancer Epidemiology, San Giovanni Battista Hospital and CPO Piemonte, Torino, Italy


Abstract
Before the introduction of new drugs, we designed a trial where treatment of newly diagnosed myeloma patients was based on the presence or absence of HLA-identical siblings. First-line treatments included a cytoreductive autograft followed by a nonmyeloablative allograft or a second melphalan-based autograft. Here, we report long-term clinical outcomes and discuss them in the light of the recent remarkable advancements in the treatment of myeloma. After a median follow-up of 7 years, median overall survival (OS) was not reached (P = .001) and event-free survival (EFS) was 2.8 years (P = .005) for 80 patients with HLA-identical siblings and 4.25 and 2.4 years for 82 without, respectively. Median OS was not reached (P = .02) and EFS was 39 months (P = .02) in the 58 patients who received a nonmyeloablative allograft whereas OS was 5.3 years and EFS 33 months in the 46 who received 2 high-dose melphalan autografts. Among patients who reached complete remission in these 2 cohorts, 53% and 19% are in continuous complete remission. Among relapsed patients rescued with “new drugs,” median OS from the start of salvage therapy was not reached and was 1.7 (P = .01) years, respectively. Allografting conferred a long-term survival and disease-free advantage over standard autografting in this comparative study.

full-text:
Long-term follow-up of a comparison of nonmyeloablative allografting with autografting for newly diagnosed myeloma