Autologous stem cell transplantation after first remission induction treatment in multiple myeloma: a report of the French Registry on autologous transplantation in multiple myeloma

Abstract

Eighteen French centers reported 133 autologous stem cell transplantations performed after first remission induction in multiple myeloma. The source of stem cell was marrow (81 cases), blood (51 cases) or marrow plus blood (1 case). The immediate outcome after transplantation was 49 (37%) complete remissions (CRs) (13 maintained, 36 achieved), 61 (46%) partial remissions, 17 failures and 5 toxic deaths. With a median follow-up of 35 months, the median remission duration was 33 months, the median time to treatment failure was 22 months. The median survival was 46 months overall, 54 months for the 103 patients responding to primary treatment, and 30 months for the 30 nonresponders. In univariate analysis, the outcome was influenced by age, Ig isotype, initial beta 2 microglobulin level, response to initial chemotherapy, plasma cell marrow involvement at the time of harvest, albumin and beta 2 microglobulin level at the time of transplantation, and CR achievement after transplantation. In multivariate analysis, the most important prognostic factor was the quality of response after transplantation. The conditioning regimen and the source of stem cell had no significant impact on immediate and long-term results. Maintenance therapy with interferon alpha did not appear to prolong remission duration or survival. Autologous stem cell transplantation is an effective consolidation for patients responding to primary treatment and a salvage therapy for some nonresponding patients. This approach has to be compared to conventional chemotherapy in prospective randomized studies. The critical impact of CR achievement on survival implies new strategies to increase the CR rate.

Long‐term outcomes of previously untreated myeloma patients: responses to induction chemotherapy and high‐dose melphalan incorporated within a risk stratification model can help to direct the use of novel treatments

“…This analysis is one of the few reports of long-term outcome for myeloma patients treated with HDM, spanning just less than two decades. These results are comparable with, if not better than, outcomes in other published series with good long-term outcomes (median survivals of approximately 5 years) and a significant proportion of patients (35%) still alive at 10 years although a plateau in survival was not reached (Harousseau et al, 1995;Alegre et al, 1998). A number of studies have confirmed the superiority of HDM compared with conventional chemotherapy (Blade et al, 1996(Blade et al, , 2001Vesole et al, 1999) The Intergroupe Francais du Myelome 90 (Attal et al, 1996) was the first randomized trial showing better response rates, which translated into a survival benefit, and was subsequently confirmed in the larger Medical Research Council (MRC) VII study (Child et al, 2003).…”

Second autologous transplant as salvage therapy in multiple myeloma

“…They were the first to demonstrate that high-dose melphalan can overcome drug resistance in patients refractory to conventional chemotherapy (McElwain & Powles, 1983). Introduction of stem cell support after high-dose chemotherapy markedly reduced the time of aplasia and, consequently, treatment-related mortality (TRM) decreased to less than 5% (Harousseau et al, 1995;Attal et al, 1996).…”

Thalidomide for the treatment of multiple myeloma

“…2000). Several studies have demonstrated that high-dose chemotherapy combined with autologous hematopoietic stem cell transplantation can prolong overall survival, compared with conventional chemotherapy (Harousseau et al . 1995;Attal et al .…”