Allogeneic hematopoietic cell transplant (HCT) may improve long-term multiple myeloma (MM) control through the graft-versus-myeloma effect. The Blood and Marrow Transplant Clinical Trials Network 0102 trial was a biologic assignment trial comparing tandem autologous transplant (auto-auto) versus autologous followed by reduced-intensity allogeneic (auto-allo) transplant in patients with newly diagnosed MM with standard-risk (n = 625) or high-risk (n = 85; β2-microglobulin at diagnosis ≥ 4 mg/dL or deletion of chromosome 13 by conventional karyotyping) disease. Although the initial 3-year analysis showed no difference in progression-free survival (PFS) between arms in either risk group, we hypothesized that long-term follow-up may better capture the impact of the graft-versus-myeloma effect. Median follow-up of survivors was over 10 years. Among standard-risk patients there was no difference in PFS (hazard ratio [HR], 1.11; 95% confidence interval [CI], .93 to 1.35; P = .25) or OS (HR, 1.03; 95% CI, .82 to 1.28; P = .82). The 6-year PFS was 25% in the auto-auto arm versus 22% in the auto-allo arm (P = .32), and 6-year overall survival (OS) was 60% and 59%, respectively (P = .85). In the high-risk group, although there was no statistically significant difference in PFS (HR, .66; 95% CI, .41 to 1.07; P = .07) and OS (HR, 1.01; 95% CI, .60 to 1.71; P = .96), a reduction in 6-year risk of relapse of 77% versus 47% (P = .005) was reflected in better PFS of 13% versus 31% (P = .05) but similar OS, at 47% versus 51% (P = .69). Allogeneic HCT can lead to long-term disease control in patients with high-risk MM and needs to be explored in the context of modern therapy.

中文翻译：

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多发性骨髓瘤患者的串联自体-自体与异体造血干细胞移植：血液和骨髓移植临床试验网络0102试验的长期随访结果。

同种异体造血细胞移植（HCT）可能通过移植物抗骨髓瘤的作用改善长期多发性骨髓瘤（MM）的控制。血液和骨髓移植临床试验网络0102试验是一项生物学研究，比较了新诊断为标准风险（MM）的MM患者的串联自体移植（auto-auto）与自体移植随后进行强度降低的同种异体（auto-allo）移植。 = 625）或高危（n = 85；诊断为≥4 mg / dL或通过常规核型分析缺失13号染色体的β2-微球蛋白）疾病。尽管最初的3年分析显示，在任一风险组中，两组之间的无进展生存期（PFS）均无差异，但我们假设，长期随访可能更好地捕捉了移植物抗骨髓瘤效应的影响。幸存者的中位随访时间超过10年。在标准风险患者中，PFS（危险比[HR]为1.11； 95％置信区间[CI]为0.93至1.35； P = .25）或OS（HR为1.03； 95％CI为0.23）没有差异。 82至1.28； P = 0.82）。自动臂的6年PFS为25％，而自动臂的6年PFS为22％（P = .32），6年总生存率（OS）分别为60％和59％（P = .85）。在高风险组中，尽管PFS（HR，.66； 95％CI，.41至1.07； P = .07）和OS（HR，1.01； 95％CI，.60至0.96）差异无统计学意义。 1.71； P = 0.96），六年复发风险降低77％比47％（P = .005）反映为PFS更好，分别为13％和31％（P = .05），但OS相似，分别为47％和51％（P = 0.69）。异基因HCT可以导致高危MM患者的长期疾病控制，需要在现代治疗的背景下进行研究。