Tandem autologous/allogeneic hematopoietic cell transplantation with bortezomib maintenance therapy for high-risk myeloma

Damian J. Green, David G. Maloney, Barry E. Storer, Brenda M. Sandmaier, Leona A. Holmberg, Pamela S. Becker, Min Fang, Paul J. Martin, George E. Georges, Michelle E. Bouvier, Rainer Storb, Marco Mielcarek*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

We evaluated tandem autologous/allogeneic hematopoietic cell transplantation followed by bortezomib maintenance therapy in a prospective phase 2 trial of treatment of high-risk multiple myeloma. The high-dose conditioning regimen for autologous hematopoietic cell transplantation consisted of melphalan 200 mg/m2. The nonmyeloablative conditioning regimen for the allogeneic transplant involved low-dose total body irradiation (2 Gy) with or without fludarabine (30 mg/m2 × 3 days). Among the 31 patients enrolled, 26 (84%) proceeded to HLA-matched allogeneic hematopoietic cell transplantation at a median of 61 (range, 41-168) days following the autologous transplant. Twenty-one patients (68%) started bortezomib (1.6 mg/m2 IV or 2.6 mg/m2 subcutaneously every 14 days for 9 months) at a median of 79 (range, 63-103) days after allogeneic transplantation. With a median follow-up of 51 (range, 16-86) months and based on intention to treat, the 2-year and 4-year progression-free survival and overall survival estimates among 24 newly diagnosed high-risk patients were 71% and 75%, and 52% and 61%, respectively. The 7 patients enrolled with relapsed or persistent disease had a 2-year and 4-year progression-free survival and overall survival rates of 14% and 43%, and 14%and 29%, respectively. These findings suggest that for patients with newly diagnosed high-riskmultiplemyeloma, bortezomibmaintenance therapy after tandem autologous/allogeneic hematopoietic cell transplantation is safe and may prevent disease progression until full establishment of a graft-versus-myeloma effect. This benefit, however, does not extend to patientswho enroll after unsuccessful prior therapy. This trial was registered at www.clinicaltrials.gov as #NCT00793572.

Original languageEnglish (US)
Pages (from-to)2247-2256
Number of pages10
JournalBlood Advances
Volume1
Issue number24
DOIs
StatePublished - Nov 14 2017

ASJC Scopus subject areas

  • Hematology

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