A comparison of allografting with autografting for newly diagnosed XXXX .

@entity1 @entity632 @entity1582 @entity619 @entity2132 @entity1891
BACKGROUND: In this trial of the treatment of newly diagnosed multiple @entity1582 , we compared a protocol that entailed a hematopoietic stem-cell autograft followed by an allograft from an HLA-identical sibling with a protocol of tandem autografts. METHODS: We enrolled 162 consecutive @entity1 with newly diagnosed @entity1582 who were 65 years of age or younger and who had at least one sibling. All @entity1 were initially treated with @entity1891 , @entity632 , and @entity619 , followed by melphalan and autologous stem-cell rescue. @entity1 with an HLA-identical sibling then received nonmyeloablative total-body irradiation and stem cells from the sibling. @entity1 without an HLA-identical sibling received two consecutive myeloablative doses of melphalan, each of which was followed by autologous stem-cell rescue. The primary end points were overall survival and event-free survival. RESULTS: After a median follow-up of 45 months (range, 21 to 90), the median overall survival and event-free survival were longer in the 80 @entity1 with HLA-identical siblings than in the 82 @entity1 without HLA-identical siblings (80 months vs. 54 months, P=0.01; and 35 months vs. 29 months, P=0.02, respectively). Among @entity1 who completed their assigned treatment protocols, treatment-related mortality did not differ significantly between the double-autologous-transplant group (46 @entity1 ) and the autograft-allograft group (58 @entity1 , P=0.09), but disease-related mortality was significantly higher in the double-autologous-transplant group (43% vs. 7%, P<0.001). The cumulative incidence rates of grades II, III, and IV @entity2132 ( @entity2132 ) combined and of grade IV @entity2132 in the autograft-allograft group were 43% and 4%, respectively. Overall, 21 of 58 @entity1 (36%) were in complete remission after a median follow-up of 38 months (range, 10 to 72) after allografting. Of the 46 @entity1 who received two autografts, 25 (54%) died. CONCLUSIONS: Among @entity1 with newly diagnosed @entity1582 , survival in recipients of a hematopoietic stem-cell autograft followed by a stem-cell allograft from an HLA-identical sibling is superior to that in recipients of tandem stem-cell autografts. (ClinicalTrials.gov number, NCT00415987 [ClinicalTrials.gov].).
