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- Title
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 Ósea phase II trial.
- Authors
Lahuerta, Juan José; Grande, Carlos; Martínez-Lopez, Joaquín; de la Serna, Javier; Toscano, Rosa; Ortiz, María Cruz; Larregla, Santiago; Conde, Eulogio; Insunza, Andrés; Gonzalez-San Miguel, José David; Bargay, Juan; Cabrera, Rafael; García-Ruiz, Juan Carlos; Albó, Carmen; García-Alonso, Luis; Solano, Fernando; Vivancos, Pilar; León, Angel; San Miguel, Jesús
- Abstract
Summary. 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.
- Subjects
MULTIPLE myeloma; STEM cells; TRANSPLANTATION of cell nuclei; SPONTANEOUS cancer regression
- Publication
British Journal of Haematology, 2003, Vol 120, Issue 2, p296
- ISSN
0007-1048
- Publication type
Article
- DOI
10.1046/j.1365-2141.2003.04067.x