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Blood, Vol. 95 No. 1 (January 1), 2000:
pp. 7-11
PLENARY PAPER
Impact on survival of high-dose therapy with autologous stem cell
support in patients younger than 60 years with newly diagnosed
multiple myeloma: a population-based study
Stig Lenhoff,
Martin Hjorth,
Erik Holmberg,
Ingemar Turesson,
Jan Westin,
Johan Lanng Nielsen,
Finn Wislöff,
Lorentz Brinch,
Kristina Carlson,
Margaretha Carlsson,
Inger-Marie Dahl,
Peter Gimsing,
Erik Hippe,
Hans Johnsen,
Jon Lamvik,
Eva Löfvenberg,
Ingerid Nesthus, and
Stig Rödjer for the Nordic Myeloma Study Group
From the Departments of Hematology, Lund University Hospital,
Sweden; Lidköping Hospital, Sweden; Sahlgrenska University
Hospital, Göteborg, Sweden; Malmö University Hospital,
Sweden; Århus University Hospital, Denmark; Ullevål Hospital,
Oslo, Norway; Rikshospitalet, Oslo, Norway; Akademiska Hospital,
Uppsala, Sweden; Linköping University Hospital, Sweden;
Tromsö University Hospital, Norway; Rigshospitalet,
Köbenhavn, Denmark; Köbenhavn University Hospital, Herlev,
Denmark; Trondheim University Hospital, Norway; Norrland University
Hospital, Umeå, Sweden; and Haukeland Hospital, Bergen, Norway.
High-dose therapy has become a common treatment for myeloma. The
objectives of this study were to estimate in a prospective, population-based setting the impact on survival of high-dose therapy in
newly diagnosed, symptomatic patients less than 60 years old and to
compare the results with those of conventionally treated historic
controls. The prospective population comprised 348 patients. Of these,
274 were treated according to a specified intensive-therapy protocol
(Nordic Myeloma Study Group [NMSG] #5/94) and constituted the
intensive-therapy group. The historic population consisted of 313 patients identified from 5 previous population-based Nordic studies. Of
these, 274 fulfilled the eligibility criteria for high-dose therapy
stated in NMSG #5/94 and constituted the control group. The expected
numbers of patients in the prospective population and the historic
population were 450 and 410, respectively, estimated from previously
established data on the incidence in this population and the population
base for each study. Survival was prolonged in the intensive-therapy
group compared with the control group (risk ratio for the control group
1.62; 95% confidence interval 1.22-2.15; P = .001). These
groups represented more than 60% of the expected number of patients.
When survival for all the registered patients in the 2 populations was
compared, representing more than 75% of the expected number of
patients, the advantage for the prospective population persisted (risk
ratio for the historic population 1.46; 95% confidence interval
1.14-1.86; P = .002). These results indicate that the
introduction of high-dose therapy for newly diagnosed myeloma has
resulted in prolonged survival for the total patient population aged
less than 60 years. (Blood. 2000; 95:7-11)
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