Melphalan 140 mg/m 2 or 200 mg/m 2 for autologous transplantation in myeloma: results from the Collaboration to Collect Autologous Transplant Outcomes in Lymphoma and Myeloma (CALM) study. A report by the EBMT Chronic Malignancies Working Party
| Autor: | Holger W. Auner, Marta Krejčí, Nigel H. Russell, Alina Tanase, Curly Morris, David Pohlreich, Paul Browne, Simona Iacobelli, Guido Kobbe, Nicolaas Schaap, Giulia Sbianchi, Wieslaw Wiktor-Jedrzejczak, Stig Lenhoff, Didier Blaise, Jane F. Apperley, Cora Knol-Bout, Esa Jantunen, Achilles Anagnostopoulos, Cecilia Isaksson, Stefan Schönland, Nicolaus Kröger, Ibrahim Yakoub-Agha, Laurent Garderet, Cyrille Touzeau, Christof Scheid |
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| Rok vydání: | 2017 |
| Předmět: |
Oncology
Melphalan medicine.medical_specialty medicine.medical_treatment Hematopoietic stem cell transplantation 03 medical and health sciences 0302 clinical medicine immune system diseases hemic and lymphatic diseases Internal medicine medicine Autologous transplantation Cumulative incidence neoplasms Survival analysis Multiple myeloma business.industry Hazard ratio Hematology medicine.disease Transplantation surgical procedures operative 030220 oncology & carcinogenesis business 030215 immunology medicine.drug |
| Zdroj: | Haematologica. 103:514-521 |
| ISSN: | 1592-8721 0390-6078 |
| Popis: | Melphalan at a dose of 200 mg/m2 is standard conditioning prior to autologous hematopoietic stem cell transplantation for multiple myeloma, but a dose of 140 mg/m2 is often used in clinical practice in patients perceived to be at risk of excess toxicity. To determine whether melphalan 200 mg/m2 and melphalan 140 mg/m2 are equally effective and tolerable in clinically relevant patient subgroups we analyzed 1964 first single autologous transplantation episodes using a series of Cox proportional-hazards models. Overall survival, progression-free survival, cumulative incidence of relapse, non-relapse mortality, hematopoietic recovery and second primary malignancy rates were not significantly different between the melphalan 140 mg/m2 (n=245) and melphalan 200 mg/m2 (n=1719) groups. Multivariable subgroup analysis showed that disease status at transplantation interacted with overall survival, progression-free survival, and cumulative incidence of relapse, with a significant advantage associated with melphalan 200 mg/m2 in patients transplanted in less than partial response (adjusted hazard ratios for melphalan 200 mg/m2versus melphalan 140 mg/m2: 0.5, 0.54, and 0.56). In contrast, transplantation in very good partial or complete response significantly favored melphalan 140 mg/m2 for overall survival (adjusted hazard ratio: 2.02). Age, renal function, prior proteasome inhibitor treatment, gender, or Karnofsky score did not interact with overall/progression-free survival or relapse rate in the melphalan dose groups. There were no significant survival or relapse rate differences between melphalan 200 mg/m2 and melphalan 140 mg/m2 patients with high-risk or standard-risk chromosomal abnormalities. In conclusion, remission status at the time of transplantation may favor the use of melphalan 200 mg/m2 or melphalan 140 mg/m2 for key transplant outcomes (NCT01362972). |
| Databáze: | OpenAIRE |
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