This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lokhorst, H. M. Articles by Sonneveld, P. Search for Related Content PubMed PubMed Citation Articles by Lokhorst, H. M. Articles by Sonneveld, P.

Partially T-Cell–Depleted Allogeneic Stem-Cell Transplantation for First-Line Treatment of Multiple Myeloma: A Prospective Evaluation of Patients Treated in the Phase III Study HOVON 24 MM

Henk M. Lokhorst, Christine M. Segeren, Leo F. Verdonck, Bronno van der Holt, Reinier Raymakers, Marinus H.J. van Oers, Renee M.Y. Barge, Harry C. Schouten, Petra H.M. Westveer, Monique M.C. Steijaert, Jan J. Cornelissen, Pieter Sonneveld for the Dutch-Belgian Hemato-Oncology Cooperative Group

From the Department of Hematology, University Medical Center Utrecht, Utrecht; Department of Hematology and HOVON Data Center, Erasmus Medical Center, Rotterdam; Department of Hematology, University Medical Center Nijmegen, Nijmegen; Department of Hematology, Academic Medical Center, Amsterdam; Department of Hematology, Leiden University Medical Center, Leiden; and Department of Hematology, Academic Medical Center, Maastricht, the Netherlands.

Address reprint requests to H.M. Lokhorst, MD, PhD, Department of Hematology, University Medical Center Utrecht, HP G03.647, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; email: H.Lokhorst{at}azu.nl.

Purpose: To determine in a prospective study the efficacy, toxicity, and long-term outcome of up-front allogeneic stem-cell transplantation (allo-SCT) in multiple myeloma (MM).

Patients and Methods: In the prospective phase III study by the Dutch-Belgian Hemato-Oncology Cooperative Group (HOVON), HOVON 24 MM, 53 patients with an HLA-identical sibling (median age at transplantation, 48 years; range, 31 to 56 years) were allocated to a partial T-cell–depleted allo-SCT after induction therapy.

Results: The overall response rate after allo-SCT was 89% (47 of 53 patients), including the 19% of patients (10 of 53 patients) with a complete remission (CR). Five patients achieved a CR only after allo-SCT. Five (71%) of seven primary refractory patients obtained a response to allo-SCT, all of whom had a partial remission. With a median follow-up of 38 months (range, 25 to 61 months), 20 patients are alive since allo-SCT and 33 patients have died (14 from progressive disease, 18 from treatment-related mortality [TRM], and one from another cause). Occurrence of acute graft-versus-host disease grades 2 to 4 predicted for higher TRM in a time-dependent analysis. The median progression-free survival time after allo-SCT was 17 months. Median overall survival time after allo-SCT was 25 months, or 29 months from the start of therapy. Only three patients are in continuing CR, indicating that the potential cure rate of this approach is, at best, 6%.

Conclusion: This first prospective evaluation of up-front allo-SCT of MM in a multicenter setting does not support the use of T-cell–depleted myeloablative allo-SCT as part of first-line therapy.

Supported by grant no. Ontwikkelingsgeneeskunde OG 96-020 from the Dutch Ministry of Health.

This article has been cited by other articles:

				P. Sonneveld, B. van der Holt, C. M. Segeren, E. Vellenga, A. J. Croockewit, G. E.G. Verhoef, J. J. Cornelissen, M. R. Schaafsma, M. H.J. van Oers, P. W. Wijermans, et al. Intermediate-dose melphalan compared with myeloablative treatment in multiple myeloma: long-term follow-up of the Dutch Cooperative Group HOVON 24 trial Haematologica, July 1, 2007; 92(7): 928 - 935. [Abstract] [Full Text] [PDF]

				S. Y. Kristinsson, O. Landgren, P. W. Dickman, A. R. Derolf, and M. Bjorkholm Patterns of Survival in Multiple Myeloma: A Population-Based Study of Patients Diagnosed in Sweden From 1973 to 2003 J. Clin. Oncol., May 20, 2007; 25(15): 1993 - 1999. [Abstract] [Full Text] [PDF]

				M. Attal, P. Moreau, H. Avet-Loiseau, and J.-L. Harousseau Stem Cell Transplantation in Multiple Myeloma Hematology, January 1, 2007; 2007(1): 311 - 316. [Abstract] [Full Text] [PDF]

				F. Garban, M. Attal, M. Michallet, C. Hulin, J. H. Bourhis, I. Yakoub-Agha, T. Lamy, G. Marit, F. Maloisel, C. Berthou, et al. Prospective comparison of autologous stem cell transplantation followed by dose-reduced allograft (IFM99-03 trial) with tandem autologous stem cell transplantation (IFM99-04 trial) in high-risk de novo multiple myeloma Blood, May 1, 2006; 107(9): 3474 - 3480. [Abstract] [Full Text] [PDF]

				S. O. Schonland, H. Lokhorst, A. Buzyn, V. Leblond, U. Hegenbart, G. Bandini, A. Campbell, E. Carreras, A. Ferrant, L. Grommisch, et al. Allogeneic and syngeneic hematopoietic cell transplantation in patients with amyloid light-chain amyloidosis: a report from the European Group for Blood and Marrow Transplantation Blood, March 15, 2006; 107(6): 2578 - 2584. [Abstract] [Full Text] [PDF]

				M. Eurelings, H. M. Lokhorst, S. Kalmijn, J.H.J. Wokke, and N. C. Notermans Malignant transformation in polyneuropathy associated with monoclonal gammopathy Neurology, June 28, 2005; 64(12): 2079 - 2084. [Abstract] [Full Text] [PDF]

				R. A. Kyle and S. V. Rajkumar Multiple Myeloma N. Engl. J. Med., October 28, 2004; 351(18): 1860 - 1873. [Full Text] [PDF]

				H. M. Lokhorst, K. Wu, L. F. Verdonck, L. L. Laterveer, N. W. C. J. van de Donk, M. H. J. van Oers, J. J. Cornelissen, and A. V. Schattenberg The occurrence of graft-versus-host disease is the major predictive factor for response to donor lymphocyte infusions in multiple myeloma Blood, June 1, 2004; 103(11): 4362 - 4364. [Abstract] [Full Text] [PDF]

				J.-L. Harousseau, J. Shaughnessy Jr., and P. Richardson Multiple Myeloma Hematology, January 1, 2004; 2004(1): 237 - 256. [Abstract] [Full Text] [PDF]