T-cell-depleted allogeneic bone marrow transplantation followed by donor lymphocyte infusion in patients with multiple myeloma: induction of graft-versus-myeloma effect
E. Alyea et al., T-cell-depleted allogeneic bone marrow transplantation followed by donor lymphocyte infusion in patients with multiple myeloma: induction of graft-versus-myeloma effect, BLOOD, 98(4), 2001, pp. 934-939
Previous trials of allogeneic bone marrow transplantation (BMT) in patients
with multiple myeloma (MM) have demonstrated high response rates but also
high transplantation-related mortality (TRM) and high relapse rates. Exploi
tation of this strategy remains of interest because donor lymphocyte infusi
ons (DLIs) can induce a potent graft-versus-myeloma (GVM) effect. CD6 T-cel
l-depleted allogeneic BMT was combined with prophylactic CD4(+) DLI adminis
tered 6 to 9 months after BMT in an effort to reduce TRM and to induce a GV
M response after BMT. Twenty-four patients with matched sibling donors and
chemotherapy-sensitive disease underwent BMT. CD6 T-cell depletion of donor
bone marrow was the sole method of graft-versus-host disease (GVHD) prophy
laxis. GVHD after BMT was minimal, 1 (4%) grade III and 4 (17%) grade II GV
HD. Fourteen patients received DLI, 3 in complete response and 11 with pers
istent disease after BMT. Significant GVM responses were noted after DLI in
10 patients with persistent disease, resulting in 6 complete responses and
4 partial responses. After DLI, 50% of patients developed acute (greater t
han or equal to 11) or extensive chronic GVHD. Two-year estimated overall s
urvival and current progression-free survival (PFS) for all 24 patients is
55% and 42%, respectively. The 14 patients receiving DLI had an improved 2-
year current PFS (65%) when compared with a historical cohort of MM patient
s who underwent CD6-depleted BMT survived 6 months with no GVHD and did not
receive DLI (41 %) (P = .13). Although this study suggests that prophylact
ic DLI induces significant GVM responses after allogeneic BMT, only 58% of
patients were able to receive DLI despite T-cell-depleted BMT. Therefore, l
ess toxic transplantation strategies are needed to allow a higher proportio
n of patients to receive DLI and the benefit from the GVM effect after tran
splantation. (C) 2001 by The American Society of Hematology.