K. Osman

Combining FDG-PET/CT with laboratory data yields superior results for prediction of relapse in multiple myeloma*

Objectives:u2002 The precise role of positron emission tomography (PET/CT) for predicting relapse/progression in multiple myeloma remains uncertain. We compared the predictive values of PET/CT, concurrent laboratory testing (labs), and their combination in prediction of 12‐month progression, as determined by current International Myeloma Working Group (IMWG) criteria.

Non-myeloablative conditioning and allogeneic transplantation for multiple myeloma†

In multiple myeloma (MM), allogeneic stem cell transplantation (alloHCT) carries a lower relapse risk than autologous transplantation but a greater transplant‐related mortality. Nonmyeloablative conditioning for allogeneic transplantation (NST) reduces transplant‐related toxicity. Results are encouraging when used during first remission in low‐risk patients, but less‐so in relapsed or refractory disease. This is a single‐center retrospective analysis of 20 previously treated MM patients who underwent NST from matched‐related or matched‐unrelated donors from 2000–2006. Median age was 52.7 years (37.2–68.0). Twenty‐five percent had advanced or high‐risk disease. Eleven still had active disease prior to NST. Conditioning was total body irradiation 200 cGy on a single fraction on day −5, followed by antithymocyte globulin (ATG) 1.5 mg/kg/day and fludarabine 30 mg/m2/day on days −4 to −2. All received immunosuppression, most commonly with oral mycofenylate mofetil and cyclosporine beginning on day −5. At day 100, 50% had achieved complete remission. Transplant‐related mortality was 25%. Median overall survival (OS) was 21.2 months (0.6–90+) and progression‐free survival (PFS) 6.6 months (0.6–90+). Both OS and PFS were 24% at 3 years. OS was significantly greater for patients with age <52 years (median 27 months vs. 7.9 months, P = 0.031), and there was a trend toward greater OS for those with β2 microglobulin <2.5 mg/l (median 27 months vs. 7.7 months, P = 0.08). Donor characteristics and Ig type had no significant effect on survival. These data suggest a benefit of NST in relapsed/refractory MM. Randomized trials must be performed to confirm and further qualify this benefit. Am. J. Hematol., 2010.

Combined bone marrow and peripheral blood progenitor cell autografts for patients with poor mobilization

BACKGROUND AIMSnPeripheral blood progenitor cell (PBPC) autografts with low CD34(+) cell content provide inadequate platelet (Plt) and red blood cell (RBC) reconstitution. Repeat collection and bone marrow (BM) harvesting are used in this situation. Minimum cell contents for BM-PBPC combined grafts are undefined.nnnMETHODSnA retrospective analysis of 19 autologous stem cell transplants (ASCT) with combined BM-PBPC for poor initial PBPC collection was carried out. Mobilization was with filgrastim (10 microg/kg/day) alone for 5 days or after chemotherapy. BM was harvested if PBPC collections were CD34+<2.5 x 10(6)/kg.nnnRESULTSnThe median age was 55 years (range 19-74). The diagnoses were multiple myeloma (7), non-Hodgkins lymphoma (7), Hodgkins disease (4) and acute myeloid leukemia (1). The median cell content (CD34+/kg x 10(6)) was 1.1 (0.3-2.7) for BM, 1.2 (0.04-2.8) for PBPC and 2.2 (1.4-4.9) combined. Eight grafts contained <2.0 x 10(6) CD34+/kg (1.4-1.8). The median engraftment in days (range) was: absolute neutrophil count (ANC) > 500, 12 (9-39); Plt > 20 000, 25 (15-70); RBC transfusion independence, 17 (6-93). Six patients died of progressive disease (58-293 days post-ASCT), one of infection on day 141 and one of AML on day 11. All patients except one maintained ANC > 1000 without filgrastim support beyond day 19. One patient had cholecystitis and delayed graft failure on day 90. PBPC CD34+ content did not predict CD34+ BM content but correlated with ANC > 500 (r= - 0.64, P=0.003). BM and combined CD34+ and BM TNC/kg did not correlate with engraftment or outcomes. Combined CD34+/kg < or > = 2.0 x 10(6) produced similar engraftment and mortality.nnnCONCLUSIONSnAfter a failed PBPC collection, BM harvest is a reliable option for obtaining an adequate combined autograft. Combined BM-PBPC autografts with <2.0x10(6) CD34+/kg can produce satisfactory engraftment.