Tandem transplants with different high-dose regimens improve the complete remission rates in multiple myeloma. Results of a Grupo Español de Síndromes Linfoproliferativos/Trasplante Autólogo de Médula Osea phase II trial.

Abstract:

:Between 1994 and 1999, 88 multiple myeloma (MM) patients were included in a phase II study to evaluate a tandem autologous stem cell transplantation (ASCT) programme. The first was conditioned with melphalan 200 mg/m2 (MEL200-ASCT1), and the second with cyclophosphamide, etoposide and BCNU (CBV-ASCT2). All patients were in response after MEL200-ASCT1. A control group of MM patients with response to a single ASCT was selected to compare outcomes. After MEL200-ASCT1, 26 patients (30%) achieved complete remission (CR). Of the remaining 48 evaluable patients, 16 (33%) achieved CR with CBV-ASCT2. The final CR rate was 48%. The 5-year survival (OS) was 55%[95% confidence interval (CI) 43-67%] while the event-free survival (EFS) was 28% (95% CI 15-39%). CR status after CBV-ASCT2 was the most important prognostic factor for OS and EFS (P = 0.00001), although no differences in outcomes were detected when the patients in CR after MEL200-ASCT1 were compared with those who obtained CR after CBV-ASCT2. Univariate and multivariate analyses showed improved OS and EFS for the tandem series as compared with the control series treated with a single MEL200-ASCT. However, in a stratified comparison by response, there were no prognostic differences between tandem patients and control patients treated with a single ASCT. In summary, our study suggests that the benefit of a second high-dose therapy course depends on its capacity to result in CR for MM patients who have not attained CR after ASCT1.

journal_name

Br J Haematol

authors

Lahuerta JJ,Grande C,Martínez-Lopez J,De La Serna J,Toscano R,Ortiz MC,Larregla S,Conde E,Insunza A,Gonzalez-San Miguel JD,Bargay J,Cabrera R,García-Ruiz JC,Albó C,García-Alonso L,Solano F,Vivancos P,León A,San Miguel

doi

10.1046/j.1365-2141.2003.04067.x

subject

Has Abstract

pub_date

2003-01-01 00:00:00

pages

296-303

issue

2

eissn

0007-1048

issn

1365-2141

pii

4067

journal_volume

120

pub_type

临床试验,杂志文章,多中心研究
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