Tandem transplants with different high-dose regimens improve the complete remission rates in multiple myeloma. Results of a Grupo Español de Síndromes Linfoproliferativos/Trasplante Autólogo de Médula Osea phase II trial.

Abstract

Between 1994 and 1999, 88 multiple myeloma (MM) patients were included in a phase II study to evaluate a tandem autologous stem cell transplantation (ASCT) programme. The first was conditioned with melphalan 200 mg/m2 (MEL200-ASCT1), and the second with cyclophosphamide, etoposide and BCNU (CBV-ASCT2). All patients were in response after MEL200-ASCT1. A control group of MM patients with response to a single ASCT was selected to compare outcomes. After MEL200-ASCT1, 26 patients (30%) achieved complete remission (CR). Of the remaining 48 evaluable patients, 16 (33%) achieved CR with CBV-ASCT2. The final CR rate was 48%. The 5-year survival (OS) was 55%[95% confidence interval (CI) 43-67%] while the event-free survival (EFS) was 28% (95% CI 15-39%). CR status after CBV-ASCT2 was the most important prognostic factor for OS and EFS (P = 0.00001), although no differences in outcomes were detected when the patients in CR after MEL200-ASCT1 were compared with those who obtained CR after CBV-ASCT2. Univariate and multivariate analyses showed improved OS and EFS for the tandem series as compared with the control series treated with a single MEL200-ASCT. However, in a stratified comparison by response, there were no prognostic differences between tandem patients and control patients treated with a single ASCT. In summary, our study suggests that the benefit of a second high-dose therapy course depends on its capacity to result in CR for MM patients who have not attained CR after ASCT1.

• Authors: Juan José Lahuerta, Carlos Grande, Joaquín Martínez-Lopez, Javier De La Serna, Rosa Toscano, María Cruz Ortiz, Santiago Larregla, Eulogio Conde, Andrés Insunza, José David Gonzalez-San Miguel, Juan Bargay, Rafael Cabrera, Juan Carlos García-Ruiz, Carmen Albó, Luis García-Alonso, Fernando Solano, Pilar Vivancos, Angel León, Jesús San Miguel, Grupo Español de Síndromes Linfoproliferativos/Trasplante Autólogo de Médula Osea
• Journal: British journal of haematology (Br J Haematol) Vol. 120 Issue 2 Pg. 296-303 (Jan 2003) ISSN: 0007-1048 [Print] England
• PMID: 12542490 (Publication Type: Clinical Trial, Clinical Trial, Phase II, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Topics

• Disease-Free Survival
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Multiple Myeloma (mortality, surgery)
• Prospective Studies
• Reoperation
• Stem Cell Transplantation (methods)
• Survival Analysis
• Transplantation Conditioning (methods)
• Transplantation, Autologous
• Treatment Outcome