Graft-versus-myeloma effect following antithymocyte globulin-based reduced intensity conditioning allogeneic stem cell transplantation

In all, 41 multiple myeloma (MM) patients received an antithymocyte globulin (ATG), fludarabine, and busulfan-based reduced intensity conditioning (RIC) for allogeneic stem cell transplantation (allo-SCT) from HLA-identical siblings. In total, 29 patients (70%) were in partial remission, one patient in complete remission, and 11 (27%) with progressive disease at the time of allo-SCT. Median time between diagnosis and allo-SCT was 24 months. The cumulative incidences of grade II - IV and grade III - IV acute graft-versus-host disease (GVHD) were 36% (95% CI, 21 - 51%) and 7% ( 95% CI, 2 - 20%), respectively. Overall, 10 patients developed limited chronic GVHD, whereas seven developed an extensive form ( cumulative incidence, 41% ( 95% CI, 26 - 56%) at 2 years). With a median follow-up of 389 days, the overall cumulative incidence of transplant-related mortality (TRM) was 17% ( 95% CI, 6 - 28%). In all, 11 patients ( 27%) are in continuous complete remission, and the Kaplan - Meier estimates of overall survival ( OS) and progression-free survival (PFS) at 2 years were 62% ( 95% CI, 47 - 76%) and 41% ( 95% CI, 23 - 62%), respectively. PFS and OS were significantly higher in patients with chronic GVHD as compared to patients without chronic GVHD ( P = 0.006 for PFS and P = 0.01 for OS). Collectively, these data demonstrate that RIC allo-SCT can mediate a potentially curative graft-versus-myeloma effect with an acceptable incidence of toxicity and TRM.