Objective
In this retrospective single‐centre study, we have looked into the transplant outcomes(overall survival OS, progression‐free survival PFS, GvHD) and the role of chimerism, DLI and pretransplant characteristics in patients who had a suboptimal response (<12 months) to an autologous stem cell transplant for myeloma and underwent an alemtuzumab T‐cell depleted reduced‐intensity allograft(RIC).
Methods
Twenty‐four patients were salvaged with two cycles of DT‐PACE and received a RIC transplant with fludarabine, melphalan and alemtuzumab. All the patients received PBSC grafts, eight patients had a sibling donor, and 16 had a graft from a fully matched unrelated donor. The median follow‐up was 65.3 months (6‐132 months).
Results
The median overall survival was 55.4 months. DLI administration was associated with a trend towards better overall survival (P=.05). Disease status at allo‐HCT, PR or VGPR, ISS score and CMV serostatus was not significant predictors of OS and PFS. Full donor whole blood chimerism (≥98%) at 3 months post‐transplant was associated with PFS (P=.04) but did not have a significant impact on OS(P=.45).
Conclusion
Reduced‐intensity alemtuzumab‐conditioned allograft for myeloma after DT‐PACE salvage chemotherapy is an efficient and low toxicity treatment for those who had a suboptimal response postautologous stem cell transplant for myeloma.