1. ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANTATION for MULTIPLE MYELOMA
Sep 29, 2018
Saurabh Chhabra, MD
Assistant Professor of Medicine
Division of Hematology/Oncology
Medical College of Wisconsin, Milwaukee WI

2. Hematopoietic Stem Cell

3. Autologous vs. Allogeneic Transplant

4. Stem cell collection/harvest
Allogeneic Hematopoietic Cell Transplantation = Stem Cell Transplantation = Bone Marrow Transplantation (BMT) Refers to the way (hematopoietic) stem cell are harvested/collected

5. Stem Cell Collection
Patient Preparation
Stem Cell Delivery

6. Allogeneic Transplant has been around for 5 decades
Allogeneic Transplant is IMMUNOTHERAPY

7. Indications for Hematopoietic Cell Transplantation in the US in 2014 (CIBMTR)

8. Allogeneic Transplant: Who can be a donor?
1. “Matched” Sibling
2. “Matched” Unrelated Volunteer adult donor
3. Partially Mismatched (“Half-matched”) Sibling, Child or Parent

9. Probability of Finding a Matched Unrelated Donor
Likelihood of Identifying a Matched Unrelated Donor (%)
White European 75
African-Americans 16
Chinese 41
Hispanics 34
Gragert L. N Engl J Med. 2014;371(4):339-48

10. Allogeneic Transplant: How to select a donor?
Matched Sibling Available?
Yes No
Matched Unrelated donor Available?
Yes No
Chemotherapy
Haploidentical (“half-matched”) family donor available?
Cord blood transplant
Go To Transplant
Yes
Clinical Trial No

11. Allogeneic Transplant: Limitations
Requires a donor
Higher mortality (10-20%)
Morbidity (rejection, infections, Graft-versus-Host Disease)
Patients need long-term anti-rejection medications
Theoretically curative: Risk of relapse is there! May still need treatment for Myeloma
Expensive!

12. Trend in Allogeneic Transplants by Patient Age

13. Trends in Allogeneic Transplants by Patient Age
The number of autologous and allogeneic transplants for treatment of malignant diseases in older patients continue to increase. Fourty-four percent of autologous transplant recipients and 22% of allogeneic transplant recipients in were older than 60.
*Transplants for AML, ALL, NHL, Hodgkin Disease, Multiple Myeloma

14. Staging Multiple Myeloma
5-Year survival
Median survival
R-ISS I
82% NR
R-ISS II
62%
87 mon.
R-ISS III
40%
56 mon.

15. High-Risk Multiple Myeloma: Definition

16. Clinical Trials of Allogeneic Transplant
1. Garban F et al. Blood. 2006 May 1;107(9):
2. Bruno B et al. N Engl J Med. 2007 Mar 15;356(11):
3. Rosinol Let al. Blood. 2008 Nov 1;112(9):
4. Gahrton G et al. Blood. 2013 Jun 20;121(25):
5. Krishnan A et al. Lancet Oncol. 2011 Dec;12(13):

17. Froedtert & Medical College of Wisconsin
% Surviving
Years after transplant
Dhakal, B et al. Clinical Lymphoma, Myeloma & Leukemia, Vol. 16, No. 7,

18. Indications for allogeneic HCT
Early relapse: <24 months after primary therapy or <18 months after autologous transplant.
Tandem autologous – allogeneic transplant in high-risk myeloma patients.
Discourage allogeneic transplant in patients with multiple relapses and truly refractory myeloma.

19. Froedtert & MCW Preference
We offer allogeneic transplant to multiple myeloma patients to
Those with early relapse (<24 months) after primary therapy that included autologous transplant OR
Those who have high-risk MM (high-risk cytogenetics, plasma cell leukemia)
AND
Those who remain sensitive to therapy, and are able to achieve remission prior to transplant

20. Thank You