Allogeneic haemopoietic stem cell transplantation for multiple myeloma or plasma cell leukaemia using fractionated total body radiation and high-dosemelphalan conditioning

We have evaluated the outcome of allogeneic haemopoietic stem cell transpla ntation for multiple myeloma using a conditioning regimen comprising fracti onated total body irradiation and high-dose melphalan (110 mg/m(2)). The st udy comprised 25 patients (median age 49 years) who had been transplanted b y either bone marrow (n = 13) or G-CSF mobilized peripheral blood stem cell s (n = 12). Overall transplant-related mortality was 30% but was lower for patients < 50 years of age at transplant (21%). The main cause of treatment -related mortality was viral infection. Of the 19 patients evaluable post-t ransplant, 17 have so far achieved complete remissions. Currently, with a m edian follow-up of 3.4 years, 18 out of 25 patients are alive, of whom 15 a re in continuing complete remission (CR) and 2 in second remission after su ffering localized relapses, which were treated with radiotherapy and donor leucocyte infusions. Patients transplanted after 1 line of previous therapy , < 50 years of age and receiving peripheral blood stem cells (PBSC) rather than bone marrow (BM) had a superior outcome, although there was no statis tically significant factor. We conclude that allogeneic transplantation sho uld be considered as a potentially curative option for younger patients wit h myeloma and that the regimen using fractionated total body irradiation an d melphalan has a high CR rate and a relatively low risk of treatment-relat ed mortality, particularly in younger patients.