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Autotransplants in multiple myeloma: what have we learned?
DH Vesole, G Tricot, S Jagannath, KR Desikan, D Siegel, D Bracy, L Miller, B Cheson, J Crowley and B Barlogie
Division of Hematology/Oncology, University of Arkansas for Medical
Sciences, Little Rock, USA.
Of 496 consecutive patients with multiple myeloma (MM) enrolled in clinical
trials of tandem transplants with peripheral blood stem cells support, 470
(95%) completed the first autotransplant with melphalan 200 mg/m2 (MEL 200)
and 363 (73%) completed the second transplant with either MEL 200 (40%),
MEL 140 mg/m2 (MEL 140) with total-body irradiation (17%), or a combination
of alkylating agents (16%), depending on the response status prior to the
second transplant; 31 patients up to age 60 years received an allograft as
the second transplant. The median interval from first to second transplant
was 5 months. Treatment-related mortality during the first year after
transplantation was 7%, and complete remission (CR) was obtained in 36%;
the median durations of event-free survival (EFS) and overall survival (OS)
after transplant were 26 and 41 months, respectively. Low beta
2-microglobulin ([B2M] < or = 2.5 mg/L) and C-reactive protein ([CRP]
< or = 0.4 mg/dL) were the most significant standard parameters
associated with both prolonged EFS and OS. Median OS exceeded 5.5 years in
the one third of patients with both low B2M and CRP. When cytogenetics were
included in the analysis, the presence of 11q abnormalities and/or complete
or partial deletion of chromosome 13 ("unfavorable karyotype") became a
dominant negative feature for both EFS and OS. In addition to these
pretransplant parameters, attainment of CR and application of two
transplants within 6 months both significantly extended EFS and OS. The
group of patients (7%) with high B2M and CRP with either IgA isotype or
unfavorable karyotype had the worst prognosis (EFS, < or = 10 months;
median OS, < or = 12 months) and will require novel therapy. We conclude
that tandem transplants are feasible in the majority of patients up to age
70 years, effecting CR in one third of all patients. Median OS was greater
than 5.5 years, regardless of pretransplant features, if the first
transplant was applied within 12 months of initial treatment and the second
transplant no more than 6 months later.
Volume 88,
Issue 3,
pp. 838-847,
08/01/1996
Copyright © 1996 by The American Society of Hematology
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