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Background <p>The optimal role of allogeneic hematopoietic stem cell transplantation (allo-SCT) in multiple myeloma (MM) remains uncertain particularly in the context of modern induction regimens and emerging immune-based therapies. We compared long-term outcomes of allo-SCT versus autologous SCT (ASCT) in a large single-center cohort.</p> Methods <p>In this retrospective study, conducted at a single center, 1,342 MM patients underwent transplantation between 1992 and 2022 (1,226 ASCT; 116 allo-SCT), with inherent differences in age and transplant eligibility between groups. Median follow-up was 101 months. Outcomes included overall survival (OS), progression-free survival (PFS), relapse incidence, and non-relapse mortality (NRM).</p> Results <p>Ten-year OS was comparable between ASCT and allo-SCT groups (59.2% vs. 64.0%; <i>p</i> = 0.38). However, allo-SCT conferred superior PFS (50.6% vs. 26.0%; <i>p</i> = 0.002), driven by a markedly lower relapse incidence (32.5% vs. 68.7%; <i>p</i> &lt; 0.001). This benefit was offset by higher NRM with allo-SCT (23.4% vs. 12.9%; <i>p</i> &lt; 0.001). Baseline laboratory markers, including elevated LDH and hypoalbuminemia, were associated with relapse and non-relapse mortality, respectively.</p> Conclusions <p>Allo-SCT offers durable disease control but is limited by treatment-related toxicity. ASCT remains the standard of care, while allo-SCT should be reserved for selected high-risk patients.</p>

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Allogeneic versus autologous transplantation in multiple myeloma: reduced relapse at the cost of higher non-relapse mortality in a large single-center cohort

  • 期刊论文

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  • 发表日期：

    2026年4月29日

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  • Sahar Tavakoli Shiraji,
  • Mohammad Biglari,
  • Maryam Barkhordar,
  • Ghazal Seghatoleslami,
  • Ghasem Janbabai,
  • Davood Babakhani,
  • Marjan Yaghmaie,
  • Soroush Rad,
  • Mohammad Vaezi,
  • Kamran Alimoghadam,
  • Hosein Kamranzadeh Fumani,
  • Seied Asadollah Mousavi,
  • Ardeshir Ghavamzadeh

摘要

Background

The optimal role of allogeneic hematopoietic stem cell transplantation (allo-SCT) in multiple myeloma (MM) remains uncertain particularly in the context of modern induction regimens and emerging immune-based therapies. We compared long-term outcomes of allo-SCT versus autologous SCT (ASCT) in a large single-center cohort.

Methods

In this retrospective study, conducted at a single center, 1,342 MM patients underwent transplantation between 1992 and 2022 (1,226 ASCT; 116 allo-SCT), with inherent differences in age and transplant eligibility between groups. Median follow-up was 101 months. Outcomes included overall survival (OS), progression-free survival (PFS), relapse incidence, and non-relapse mortality (NRM).

Results

Ten-year OS was comparable between ASCT and allo-SCT groups (59.2% vs. 64.0%; p = 0.38). However, allo-SCT conferred superior PFS (50.6% vs. 26.0%; p = 0.002), driven by a markedly lower relapse incidence (32.5% vs. 68.7%; p < 0.001). This benefit was offset by higher NRM with allo-SCT (23.4% vs. 12.9%; p < 0.001). Baseline laboratory markers, including elevated LDH and hypoalbuminemia, were associated with relapse and non-relapse mortality, respectively.

Conclusions

Allo-SCT offers durable disease control but is limited by treatment-related toxicity. ASCT remains the standard of care, while allo-SCT should be reserved for selected high-risk patients.