Objective: To evaluate the safety and prognosis of allogenetic stem cells transplantation in younger patients with multiple myeloma.
Methods: We retrospectively investigated 32 young patients (median age: 45 years) diagnosed with multiple myeloma and received allogenetic stem cells transplantation in Changzheng Hospital. The non-relapse mortality, disease-related mortality, incidences of acute and chronic graft-versus-host disease (GVHD), and survivals of the patients were analyzed.
Results: Transplantation was successful in 31 of all the patients. Response could be evaluated in 28 patients. The complete response (CR)rate before transplantation was 25.0% (8/32), which rose to 82.1% (23/28) after transplantation.And 53.1% (17/32) of the patients developed acute GVHD, with 43.8% (14/32) developing grade Ⅰ-Ⅱ; 40.6% (13/32) of the patients developed chronic GVHD, with no extensive one. The median follow-up time was 18.1 (0.4-145.8) months.Sixteen patients died, including 10 cases of non-relapse deaths and 6 cases of disease-related deaths. The non-relapse mortality within 100 days was 9.4% (3/32). The 1-, 2-and 3-year non-relapse mortality rates were 21.9% (7/32), 28.1% (9/32) and 31.3% (10/32), respectively. The common causes of non-relapse mortality were pulmonary infection (7/10), acute GVHD (1/10), acute renal failure (1/10), and acute myocardial infarction (1/10). The disease-related mortality was 18.8% (6/32). The 1-, 2-and 3-year progression-free survival rates were 61.6%, 42.2%, and 37.5%, respectively. The median duration of progression-free survival was 20.3 months. The 1-, 2-and 3-years overall survival were 68.4%, 52.4% and 42.8%, respectively. The median duration of overall survival was 28.3 months. Patients that survived for over 2 years were all alive at the end of the follow-up.
Conclusions: Allogenetic stem cell transplantation may be a promising curative therapeutic choice for young multiple myeloma patients. Transplantation-related death is the primary factor of prognosis. Pulmonary infection with infectious shock is the most common cause of non-relapse mortality. Prevention of infection after transplantation is the key to improve survivals.