Tandem Autologous/Reduced-Intensity Conditioning Allogeneic Stem-Cell Transplantation Versus Autologous Transplantation in Myeloma: Long-Term Follow-Up

TLDR: In patients with previously untreated multiple myeloma, long-term outcome with respect to progression-free survival, overall survival, and relapse rate is superior after auto-allo compared with auto only, and nonrelapse mortality is at a reasonable level in both groups.

Abstract: Purpose Results of allogeneic stem-cell transplantation (allo) in myeloma are controversial. In this trial autologous stem-cell transplantation (auto) followed by reduced-intensity conditioning matched sibling donor allo (auto-allo) was compared with auto only in previously untreated multiple myeloma. Patients and Methods In all, 357 patients with myeloma up to age 69 years were enrolled from 2001 to 2005. Patients with an HLA-identical sibling donor were allocated to the auto-allo arm (n = 108) and patients without a matched sibling donor were allocated to the auto arm (n = 249). Single (n = 145) or tandem (n = 104) auto was optional. Conditioning for the auto arm was melphalan 200 mg/m2; conditioning for the allo arm was total-body irradiation 2 Gy plus fludarabine 30 mg/m2/d for 3 days. Median follow-up time was 61 months. Primary end point was progression-free survival. Results Progression-free survival at 60 months was significantly better with auto-allo than with allo alone (35% v 18%; P = .001), as...