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Blood, Vol. 95 No. 7 (April 1), 2000:
pp. 2234-2239
Engraftment, clinical, and molecular follow-up of patients with
multiple myeloma who were reinfused with highly purified CD34+
cells to support single or tandem high-dose chemotherapy
Roberto M. Lemoli,
Giovanni Martinelli,
Elena Zamagni,
Maria Rosa Motta,
Simonetta Rizzi,
Carolina Terragna,
Roberto Rondelli,
Sonia Ronconi,
Antonio Curti,
Francesca Bonifazi,
Sante Tura, and
Michele Cavo
From the Institute of Hematology and Medical Oncology "L. & A. Seragnoli" and Department of Pediatrics, University of Bologna,
Bologna, Italy.
Eighty-two patients with advanced multiple myeloma (MM) were
enrolled in 2 sequential clinical studies of 1 or 2 courses of myeloablative therapy with stem cell support. Conditioning regimens consisted of high-dose melphalan (MEL) with or without total body irradiation (TX1 = 35) and MEL as the first preparative regimen, followed within 6 months by busulfan and melphalan (TX2 = 47). On
the basis of adequate stem cell harvest, 31 patients (TX1 = 13;
TX2 = 18) were transplanted with highly purified CD34+ cells. Positively selected stem cells did not adversely affect hematopoietic reconstitution compared with unmanipulated peripheral blood stem cell.
Overall, the complete remission (CR) rate of evaluative patients was
13.8% and 41% for single and double autotransplant, respectively
(P = .04). Moreover, 3 patients undergoing TX2 achieved molecular remission and 2 remain PCR-negative after 36 and 24 months
from autograft. The median event-free survival (EFS) durations for TX1
and TX2 were 17 and 35 months, respectively (P = .03). Actuarial 3-year overall survival for patients treated with 1 or 2 transplants are 76% and 92%, respectively (P = NS). On
multivariate analysis, superior EFS was associated with low  2
microglobulin (2-M) level at diagnosis and TX2, whereas overall
survival was correlated with 2-M. Positive selection of CD34+
cells did not influence the achievement of clinical or molecular CR, as
well as remission duration or survival of MM patients. Thus, whereas multiple cycles of high-dose therapy may be beneficial for patients with myeloma, the clinical impact of tumor cell purging remains highly questionable.
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