Allogeneic stem-cell transplantation in multiple myeloma patients at the Hematology Department of the University Medical Centre Ljubljana

Abstract

Background: Multiple myeloma (MM) is an incurable malignant clonal plasma cell disorder. Allogeneic stem-cell transplantation (SCT) is a possible treatment for limited number of patients. It is associated with high treatment-related mortality (TRM), mainly due to complications related to graft versus host disease (GVHD). Methods: We retrospectively analyzed all patients that were treated by allogeneic stem-cell transplantation at our departement between the years 1998 until the end of 2011. Results: In the period from 1 January 1998 to 31 December 2011, 22 multiple myeloma patients were treated by allogeneic SCT. Their median age was 46 years, ranging from 36 to 66 years. There were 11 (50 %) women and 11 (50 %) men. Prior to allogeneic SCT, 1/22 (4.5 %) patients had a complete response (CR), 9/22 (40.9 %) had a very good partial response (VGPR), 7/22 (31.8 %) a partial response (PR) and 5/22 (22.7 %) had a progressive disease (PD); 8/22 (36.3 %) had acute GVHD, and the same number of patients developed chronic GHVD; 9/22 (40.9 %) had cytomegalovirus reactivation. At the time of analysis, 13/22 (59 %) patients were still alive. Among those, 11/13 (84.6 %) had a CR or VGPR, 1/13 (7.7 %) a PR, 1/14 (7.7 %) had a stable disease. 9/22 (40.9 %) patients died: 5/9 (55.5 %) due to GVHD, 3/9 (33.3 %) due to disease progression, and 1/9 (11.1 %) following infection. Conclusions: Because of high TRM and impaired quality of life due to chronic GVHDrelated complications, allogeneic SCT is still reserved for a small group of MM patients. These are usually younger patients at high risk of progression and early relapse of the disease. We do not recommend allogeneic SCT to patients with late stages of the disease who are refractory to the prior therapy. It is also very important to achieve a low tumor burden (CR, VGPR) prior to allogeneic SCT