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Blood, 15 February 2008, Vol. 111, No. 4, pp. 1751-1752. This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Jagannath, S. Search for Related Content PubMed Articles by Jagannath, S. Related Collections Related Article in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CLINICAL OBSERVATIONS Comment on Abdelkefi et al, page 1805 Is tandem autotransplantation necessary in myeloma? Sundar Jagannath ST VINCENT'S COMPREHENSIVE CANCER CENTER In this issue of Blood, Abdelkefi and coworkers use a randomized trial to show that the immunomodulatory agent thalidomide, applied after a single transplantation for 6 months, results in improved response rates and better progression-free and overall survival (OS) compared with tandem transplantation. Recent availability of novel agents for the treatment of myeloma has resulted in exploration of their use in several different clinical settings.1–3 Abdelkefi and colleagues have attempted to replace high-dose melphalan with a modest course of thalidomide (100 mg daily for 6 months). The provocative results of their study raise the question of whether effective maintenance therapy after one transplant obviates the need for tandem transplantation. However, the study does raise some questions. The 3-year survival of patients in the tandem transplantation arm is similar to that in the Intergroupe Francophone du Myélome (IFM)–96 trial, but significantly inferior to that in the Bologna-96 study.4,5 However, it is remarkable that the 3-year 88% survival of patients in the single transplantation arm is remarkably better than in the single transplantation arms of the IFM and Bologna studies. Can such differences be attributable solely to thalidomide? While thalidomide was available as effective salvage therapy for patients relapsing after tandem transplantation, other effective agents such as bortezomib or lenalidomide were not available. How many patients from each arm relapsed, and what their responses were to salvage therapy, is rather difficult to discern from this paper. The fact that 15 of the 18 patients who received thalidomide for relapse died of progressive disease in a relatively short period of time is unusual. In the long-term follow-up of their original observation, Barlogie et al1 showed almost 50% of patients were alive at 2 years following thalidomide monotherapy. In the era of effective salvage therapy, it is rather unusual to see virtually identical event-free survival and OS in each arm of the study. This study, although provocative, needs confirmation in a setting where other appropriate salvage therapy options are available to the patients. There are several ongoing clinical trials exploring the role of novel agents in the maintenance setting. Until more data are available, second transplantation should not be abandoned. Footnotes Conflict-of-interest disclosure: The author declares no competing financial interests. REFERENCES Barlogie B, Desikan R, Eddlemon P, et al. Extended survival in advanced and refractory multiple myeloma after single-agent thalidomide: identification of prognostic factors in a phase 2 study of 169 patients. Blood 2001; 98:492–494.[Abstract/Free Full Text] Richardson PG, Barlogie B, Berenson J, et al. A phase 2 study of bortezomib in relapsed, refractory myeloma. N Engl J Med 2003; 348:2609–2617.[Abstract/Free Full Text] Richardson PG, Schlossman RL, Weller E, et al. Immunomodulatory drug CC-5013 overcomes drug resistance and is well tolerated in patients with relapsed multiple my-eloma. Blood 2002; 100:3063–3067.[Abstract/Free Full Text] Attal M, Harousseau JL, Facon T, et al. Single versus double autologous stem-cell transplantation for multiple myeloma. N Engl J Med 2003; 349:2495–2502.[Abstract/Free Full Text] Cavo M, Tosi P, Zamagni E, et al. Prospective, randomized study of single compared with double autologous stem-cell transplantation for multiple myeloma: Bologna 96 clinical study. J Clin Oncol 2007; 25:2434–2441.[Abstract/Free Full Text] CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Article in Blood Online: Single autologous stem-cell transplantation followed by maintenance therapy with thalidomide is superior to double autologous transplantation in multiple myeloma: results of a multicenter randomized clinical trial Abderrahman Abdelkefi, Saloua Ladeb, Lamia Torjman, Tarek Ben Othman, Amel Lakhal, Neila Ben Romdhane, Halima El Omri, Moez Elloumi, Hatem Belaaj, Ramzi Jeddi, Lamia Aissaouï, Habib Ksouri, Assia Ben Hassen, Fahmi Msadek, Ali Saad, Mohamed Hsaïri, Kamel Boukef, Ahlem Amouri, Hechmi Louzir, Koussay Dellagi, and Abdeladhim Ben Abdeladhim, on behalf of the Tunisian Multiple Myeloma Study Group Blood 2008 111: 1805-1810. [Abstract] [Full Text] [PDF] This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Jagannath, S. Search for Related Content PubMed Articles by Jagannath, S. Related Collections Related Article in Blood Online Social Bookmarking                   What's this?

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