期刊
BLOOD
卷 113, 期 14, 页码 3375-3382出版社
AMER SOC HEMATOLOGY
DOI: 10.1182/blood-2008-07-167379
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- Progetti di Ricerca ex-60% (Torino, Italy)
- Ministero dell'Universita e della Ricerca Scientifica (MIUR
- Rome, Italy)
- Regione Piemonte (Torino, Italy): Ricerca Finalizzata 2005
- Compagnia di San Paolo (Torino, Italy)
- Fondazione Cassa di Risparmio di Torino (CRT
- Torino, Italy)
- Comitato Regionale Piemontese Gigi Ghirotti (Progetto Vita Vitae
- Rome, Italy)
- Fondazione Neoplasie Sangue Onlus (Torino, Italy)
- National Institutes of Health, Department of Health and Human Services (Bethesda, MD) [CA78902]
Despite recent advances, allografting remains the only potential cure for myeloma. From July 1999 to June 2005, 100 newly diagnosed patients younger than 65 years were enrolled in a prospective multicenter study. First-line treatment included vincristin, adriamycin, and dexamethasone (VAD) based induction chemotherapy, a cytoreductive autograft (melphalan 200 mg/m(2)) followed by a single dose of nonmyeloablative total body irradiation and allografting from an human leukocyte antigen (HLA) identical sibling. Primary end points were the overall survival (OS) and event-free survival (EFS) from diagnosis. After a median follow-up of 5 years, OS was not reached, and EFS was 37 months. Incidences of acute and chronic graft-versus-host disease (GVHD) were 38% and 50%, respectively. Complete remission (CR) was achieved in 53% of patients. Profound cytoreduction (CR or very good partial remission) before allografting was associated with achievement of posttransplantation CR (hazard ratio [HR] 2.20, P = .03) and longer EFS (HR 0.33, P < .01). Conversely, development of chronic GVHD was not correlated with CR or response duration. This tandem transplantation approach allows prolonged survival and long-term disease control in patients with reduced tumor burden at the time of allografting. We are currently investigating the role of new drugs in intensifying pretransplantation cytoreduction and posttransplantation graft-versus-myeloma effects to further improve clinical outcomes. (http://ClinicalTrials.gov; NCT-00702247.) (Blood. 2009;113:3375-3382)
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