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Superiority of tandem autologous transplantation over standard therapy for
previously untreated multiple myeloma
B Barlogie, S Jagannath, DH Vesole, S Naucke, B Cheson, S Mattox, D Bracy, S Salmon, J Jacobson, J Crowley and G Tricot
Division of Hematology/Oncology, University of Arkansas for Medical
Sciences, Little Rock 72205, USA.
Virtually no progress has been made during more than 2 decades of clinical
trials for multiple myeloma (MM) involving standard therapy (ST). Recent
studies suggest that dose intensification requiring hematopoietic stem cell
support results in higher complete response (CR) rates and extended disease
control. "Total Therapy" (TT) consisting of noncross-resistant induction
regimens, followed by a double autotransplant (AT) procedure, was
administered to 123 untreated patients with symptomatic MM. Upon
hematologic recovery, interferon (IFN) maintenance (3 million units [MU]/m2
subcutaneously thrice weekly) was given until disease
recurrence/progression. Results were compared with the outcome of untreated
patients receiving ST according to Southwest Oncology Group (SWOG) trials.
One hundred sixteen pair mates were selected from both TT and among 1,123
patients to match for the major prognostic features. TT induced CR in 40%
of all 123 patients (intent-to-treat). By 12 months, 7% had died, including
4% from treatment-related complications. With a median follow-up of 31
months, median durations of event-free survival (EFS) and overall survival
(OS) are 49 and 62+ months, respectively. Abnormalities of chromosomes 11q
and 13 were associated with inferior outcome, whereas CR within 6 months
after induction was a favorable prognostic feature for both EFS and OS. In
comparison to ST, TT induced higher PR rates (85% v 52%, P < .0001) (CR
rates not available on SWOG trials) and extended EFS (49 v 22 months, P =
.0001) and OS (62+ v 48 months, P = .01). Compared to ST, dose
intensification with double AT markedly augments tumor cytoreduction,
effecting not only higher CR rates but also significantly extending EFS and
OS in previously untreated patients with MM.
Volume 89,
Issue 3,
pp. 789-793,
02/01/1997
Copyright © 1997 by The American Society of Hematology
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