Comparison of twin and autologous transplants for multiple myeloma Journal Article


Authors: Bashey, A.; Pérez, W. S.; Zhang, M. J.; Anderson, K. C.; Ballen, K.; Berenson, J. R.; To, L. B.; Fonseca, R.; Freytes, C. O.; Gale, R. P.; Gibson, J.; Giralt, S. A.; Kyle, R. A.; Lazarus, H. M.; Maharaj, D.; McCarthy, P. L.; Milone, G. A.; Nimer, S.; Pavlovsky, S.; Reece, D. E.; Schiller, G.; Vesole, D. H.; Hari, P.
Article Title: Comparison of twin and autologous transplants for multiple myeloma
Abstract: Relapse is the overwhelming cause of treatment failure after autologous transplantation for multiple myeloma (MM). For patients with a syngeneic donor, twin transplants provide a healthy graft that is free of myeloma. The relative impact of the graft on posttransplant relapse can be estimated by comparing risk of relapse after hematopoietic cell transplantation from genetically identical twins versus autotransplants because confounding differences in minor or major histocompatibility antigens are absent in the syngeneic transplant setting. Outcomes of 43 subjects who received twin transplants for MM were compared to 170 matched autotransplant recipients reported to the Center for International Blood and Marrow Transplant Research (CIBMTR). Multivariate analysis was performed by fitting a Cox model stratified on matched pairs. The matched transplant patients studied were similar with respect to subject-, disease-, and transplant-related characteristics. Cumulative incidence of relapse/progression was significantly lower, and progression-free survival (PFS) was significantly higher following twin transplants. In multivariate analysis, the probability of relapse/progression was lower in twins (relative risk [RR] = 0.49, 95% confidence interval [CI] 0.28-0.86, P = .011). Twin transplants have a significantly lower relapse risk than autotransplants in MM, suggesting that graft composition may impact outcomes following high-dose chemotherapy. © 2008 American Society for Blood and Marrow Transplantation.
Keywords: adult; controlled study; treatment outcome; aged; disease-free survival; middle aged; major clinical study; busulfan; thalidomide; disease course; interferon; drug megadose; antineoplastic agent; interleukin 2; multiple myeloma; etoposide; incidence; relapse; recurrence; bisphosphonic acid derivative; cyclophosphamide; melphalan; hematopoietic stem cell transplantation; carmustine; confidence interval; proportional hazards model; probability; intermethod comparison; multivariate analysis; analysis of variance; transplantation, autologous; graft recipient; transplantation immunology; transplantation, isogeneic; autotransplantation; autotransplant; graft-versus-myeloma; twin; twins, monozygotic
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 14
Issue: 10
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2008-10-01
Start Page: 1118
End Page: 1124
Language: English
DOI: 10.1016/j.bbmt.2008.07.007
PUBMED: 18804041
PROVIDER: scopus
PMCID: PMC2584240
DOI/URL:
Notes: --- - "Cited By (since 1996): 7" - "Export Date: 17 November 2011" - "CODEN: BBMTF" - "Source: Scopus"
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  1. Stephen D Nimer
    347 Nimer