TREATMENT OF MYELOMA USING INTENSIVE THERAPY AND ALLOGENEIC BONE-MARROW TRANSPLANTATION

Over a 5-year period we evaluated 65 myeloma patients aged less than or equal to 55 years as potential candidates for intensive therapy and allogeneic BMT, Twenty six (40%) patients were transplanted; the median duration of disease was 4 months (range 2-58 months) and median number of prior regimens was 1 (range 1-5); all but five patients had chemosensitive disease, Conditioning regimens included combinations of BU + CY + MEL in 14 patients, BUCY2 in eight and CY + TBI in four, Donors were HLA-matched siblings in 19 cases, one antigen mismatched siblings in three and unrelated donors in four, All patients received CsA, plus either methylprednisolone (n = 5) or MTX with or without other agents (n = 19). Grade III or IV regimen-related toxicity (RRT) was relatively infrequent (3 patients) and was not seen in nine patients conditioned with BU (total dose 12 mg/kg) + MEL (100 mg/m(2)) + CY (90 mg/m(2)). Grade II-IV acute GVHD occurred in 20 patients, and was the cause of death in three, Chronic GVHD also caused three deaths, Thirteen of 21 evaluable patients (62%) achieved a CR and six achieved a PR. Actuarial progression-free survival (PFS) was 40% (95% confidence interval (CI) 19-61%) at a median follow-up of 14 months (range 3-56 months); the PFS was 52% (95% CI 24-74%) in chemoresponsive patients, compared with 0% in chemoresistant patients (P = 0.0066). Our experience confirms that intensive therapy and allogeneic BMT can produce long-term PFS in a proportion of patients with myeloma, Measures to reduce GVHD and optimize use of alternative donors should increase the effectiveness of this approach