Tandem Transplantation in Multiple Myeloma Prolongs Survival, Predominantly in Patients Achieving Partial Remission after the First Cycle of High-Dose Therapy

Autor: M. Hoiczyk, Siegfried Seeber, Siemke Mueller, M. R. Nowrousian, Jörg Hense, Dieter Brandhorst, P. Schuett, Anja Welt, Miriam Poser, T. Wrzeciono, K. Metz, T. Moritz, Michael Flasshove
Rok vydání: 2006
Předmět:
Zdroj: Blood. 108:5446-5446
ISSN: 1528-0020
0006-4971
Popis: Introduction. The group of patients (pts) with multiple myeloma (MM) who benefit from two cycles of high-dose (HD) melphalan (MP) has not yet been clearly defined. In this single-institution, nonrandomized study, we evaluate the long-term results of tandem HDMP and peripheral blood stem cell transplantation (PBSCT) in previously untreated pts and investigate the pretherapeutic and therapeutic factors predictive for survival. Patients and treatment. From 2/94 to 10/05, 90 pts were included. Pt characteristics: Age median 53 (range 31–70, 29% >60 yrs), m/f 59/41%, MM stage I/II/III 5/23/72%, A/B 88/12% (Durie/Salmon), Bence Jones protein 42%, albumin 2.5 mg/mL 70%, CRP >5 mg/L 61%, IL2-receptor elevated 49%, and thymidine kinase>10 U/L 48%. 28% of pts received HD dexamethasone and 72% conventional-dose chemotherapy, mainly VAD-based, prior to intended 2 (administered 1–3) cycles of HD cyclophosphamide (CY) (2–3 g/m2, days 1+2) and 2 (administered 0–3) cycles of HDMP (100 mg/m2, days 1+2). HDCY cycles were supported by G-CSF or GM-CSF and HDMP cycles by autologous PBSC and G-CSF. PBSC were collected after the first or second cycle of HDCY. Results. 14% (n=13) of pts received only CY, 30% (n=27) 1 cycle of HDMP, and 56% 2–3 cycles (n=47/3), depending on treatment complications, number of PBSC available, and patient compliance. 54% of pts achieved CR (defined as disappearance of myeloma protein in serum and urine and 50% and in urine >90% from baseline), and 3% no change after completion of treatment. 7% of pts died during treatment. With a median follow-up of 5.8 yrs, the probability of overall survival (OS) for the entire group of pts was 48% and 41% at 5 and 7 yrs, respectively, and the probability of progression-free survival (PFS) 35% and 21%. In multivariate analysis, CRP ≤5 mg/L and b2MG ≤2.5 mg/mL were independent positive pretherapeutic parameters for OS and b2MG ≤2.5 mg/mL for PFS. Among the therapeutic factors, achievement of CR after completion of treatment and the use of tandem HDMP independently predicted prolonged OS and PFS. Pts who achieved CR had a median OS and PFS of 110 and 64 months, respectively, compared with 45 and 27 months in pts with PR or NC (p Conclusion. The results of this study clearly show a long-term benefit from tandem HDMP in pts with MM, including those age > 60 yrs. This benefit is particularly evident in pts achieving PR after the first cycle of HD treatment.
Databáze: OpenAIRE
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