J Hematol

Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc

Journal website https://jh.elmerpub.com

Letter to the Editor

Volume 14, Number 1, February 2025, pages 38-42

Allogeneic Stem Cell Transplantation for High/Ultra High-Risk Multiple Myeloma

↓ Figure 1. Swimming plot of allogeneic transplant outcomes for each patient. VAD: vincristine, doxorubicin, and dexamethasone; DT-PACE: dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, and etoposide; VTD-PACE: bortezomib dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, and etoposide; VelDex: bortezomib and dexamethasone; LenDex: lenalidomide and dexamethasone; BuCy: busulfan and cyclophosphamide; FluCy: fludarabine and cyclophosphamide; HDM: high-dose melphalan; MRD: minimal residual disease.

↓ **Table 1.** Reported Outcomes and Demographics of Single-Center AlloT
AlloT: allogeneic transplantation; GVHD: graft-versus-host disease; RIC: reduced-intensity conditioning; OS: overall survival; VAD: vincristine, doxorubicin, and dexamethasone; DT-PACE: dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, and etoposide; VTD-PACE: bortezomib dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, and etoposide; VelDex: bortezomib and dexamethasone; LenDex: lenalidomide and dexamethasone; BuCy: busulfan and cyclophosphamide; FluCy: fludarabine and cyclophosphamide; HDM: high-dose melphalan; HLA: human leukocyte antigen.
Demographics
Gender	Male (n = 6, 75%), female (n = 2, 25%)
Race	Caucasian (n = 4, 50%), African American (n = 3, 37.5%), Asian (n = 1, 12.5%)
Median age at diagnosis	51 years (35.7 - 72.4)
Median age at transplant	52.5 years (36.4 - 72.8)
Disease characteristics
R-ISS stage at diagnosis	Stage II (n = 5, 62.5%), stage IIIA (n = 3, 37.5%)
Previous autologous transplant	n = 6, 75%
Transplant characteristics
Transplant type	HLA-matched sibling (n = 7, 87.5%), syngeneic twin (n = 1, 12.5%)
Median time to AlloT from diagnosis	0.92 years
Initial therapies	VAD (n = 1, 12.5%), DT-PACE (n = 1, 12.5%), VTD-PACE (n = 1, 12.5%), VelDex (n = 1, 12.5%), LenDex (n = 4, 50%)
Conditioning regimens	BuCy (n = 3, 37.5%), FluCy (n = 4, 50%), HDM (n = 1, 12.5%)
GVHD incidence	Mild acute (n = 2, 25%), chronic grade I (n = 5, 62.5%), none (n = 1, 12.5%)
Survival outcomes
Alive at 1 year	75%
Alive at 5 years	62.50%
RIC OS	50% (2 years), 50% (5 years)
Myeloablative OS	100% (2 years), 75% (5 years)
Median overall survival	6.7 years (1.8 - 20.1)
Relapse and mortality
Relapse rate	71% (10 year)
Median time to relapse	3.64 years (0.21 - 9.33)
Time to death post-transplant	7.89 years (0.37 - 17.6)

↓ Table 1. Reported Outcomes and Demographics of Single-Center AlloT

AlloT: allogeneic transplantation; GVHD: graft-versus-host disease; RIC: reduced-intensity conditioning; OS: overall survival; VAD: vincristine, doxorubicin, and dexamethasone; DT-PACE: dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, and etoposide; VTD-PACE: bortezomib dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, and etoposide; VelDex: bortezomib and dexamethasone; LenDex: lenalidomide and dexamethasone; BuCy: busulfan and cyclophosphamide; FluCy: fludarabine and cyclophosphamide; HDM: high-dose melphalan; HLA: human leukocyte antigen.

Demographics

Gender

Male (n = 6, 75%), female (n = 2, 25%)

Race

Caucasian (n = 4, 50%), African American (n = 3, 37.5%), Asian (n = 1, 12.5%)

Median age at diagnosis

51 years (35.7 - 72.4)

Median age at transplant

52.5 years (36.4 - 72.8)

Disease characteristics

R-ISS stage at diagnosis

Stage II (n = 5, 62.5%), stage IIIA (n = 3, 37.5%)

Previous autologous transplant

n = 6, 75%

Transplant characteristics

Transplant type

HLA-matched sibling (n = 7, 87.5%), syngeneic twin (n = 1, 12.5%)

Median time to AlloT from diagnosis

0.92 years

Initial therapies

VAD (n = 1, 12.5%), DT-PACE (n = 1, 12.5%), VTD-PACE (n = 1, 12.5%), VelDex (n = 1, 12.5%), LenDex (n = 4, 50%)

Conditioning regimens

BuCy (n = 3, 37.5%), FluCy (n = 4, 50%), HDM (n = 1, 12.5%)

GVHD incidence

Mild acute (n = 2, 25%), chronic grade I (n = 5, 62.5%), none (n = 1, 12.5%)

Survival outcomes

Alive at 1 year

75%

Alive at 5 years

62.50%

RIC OS

50% (2 years), 50% (5 years)

Myeloablative OS

100% (2 years), 75% (5 years)

Median overall survival

6.7 years (1.8 - 20.1)

Relapse and mortality

Relapse rate

71% (10 year)

Median time to relapse

3.64 years (0.21 - 9.33)

Time to death post-transplant

7.89 years (0.37 - 17.6)

↓ **Table 2.** Summary of Recent Allogenic Transplant Outcome Data
References	N	Overall survival	Progression-free survival	Relapse rate
All values are reported as percentages of the cohort that died, progressed, or relapsed over the defined time-period. ^aReduced intensity conditioning, ^bnon-myeloablative, ^cmyeloablative conditioning, and ^dconventional autologous hematopoietic cell transplantation are used to achieve a minimal disease burden prior to allografting.
Hayden et al 2021 [9]	215	38%^d	25%^d	17%^d	6%^d	68%^d	-	79%^d
Sahebi et al, 2019 [7]	96	48%	-	17%	-	56%	-	-
Hayden et al, 2020 [3]	344	-	39%^a, 45%^b, 19%^c, 34%^d	-	15%^a, 17%^b, 14%^c, 15%^d	-	52.7%^a, 50.2%^b, 48.1%^c, 58.3%^d	-
Schmidt et al, 2023 [10]	91	-	20%^a, 8%^b, 28%^c	-	14%^a, 0%^b, 20%^c	-	-	-
Jurgensen-Rauch et al, 2021 [8]	37	-	66%^a	-	48%^a	-	-	50%^a
Eisfeld et al, 2020 [6]	90	53%	39%	36%	25%	-	-	-

↓ Table 2. Summary of Recent Allogenic Transplant Outcome Data

References

Overall survival

Progression-free survival

Relapse rate

2-year

5-year

2-year

5-year

2-year

3-year

5-year

All values are reported as percentages of the cohort that died, progressed, or relapsed over the defined time-period. ^aReduced intensity conditioning, ^bnon-myeloablative, ^cmyeloablative conditioning, and ^dconventional autologous hematopoietic cell transplantation are used to achieve a minimal disease burden prior to allografting.

Hayden et al 2021 [9]

215

38%^d

25%^d

17%^d

6%^d

68%^d

79%^d

Sahebi et al, 2019 [7]

48%

17%

56%

Hayden et al, 2020 [3]

344

39%^a, 45%^b, 19%^c, 34%^d

15%^a, 17%^b, 14%^c, 15%^d

52.7%^a, 50.2%^b, 48.1%^c, 58.3%^d

Schmidt et al, 2023 [10]

20%^a, 8%^b, 28%^c

14%^a, 0%^b, 20%^c

Jurgensen-Rauch et al, 2021 [8]

66%^a

48%^a

50%^a

Eisfeld et al, 2020 [6]

53%

39%

36%

25%