Outcome assessment of a population-based group of 195 unselected myeloma patients under 70 years of age offered intensive treatment

Abstract

Summary:OS yet to reach a median at 8 years and a PFS of 44 months, significantly better than non IFN high-dose A single centre series of 195 consecutive newly diagpatients (P Ͻ 0.0036). However, although we showed nosed untreated myeloma patients under 70 years, seen benefit for selected patients in studies and trials between September 1986 and March 1994, were ana-(particularly with IFN) during the 8-year period of the lysed to assess the impact of current intensive treatment series, this did not translate into overall PFS benefit in methods upon remission rate, response rate and subour study for unselected cohorts of patients for 1986-sequent outcome. They were predominantly an unselec-1988 (64 patients) 1989-1992 (100 patients) and 1992-ted population based group of patients (other than by 1994 (31 patients) in spite of progressive increases in age) that could be used by purchasers of health care the proportion of patients receiving IFN (respectively 6, as a model for outcome assessment. All patients were 35 and 58%). This is likely to be due to the dilution scheduled to receive a care plan which included a of benefit to specific patients by the overall number of sequential package of treatment consisting initially of patients involved. Outcome data from unselected courses of infusional chemotherapy using vincristine, patients are now expected by purchasers and presented adriamycin and methyl prednisolone (VAMP) and 90 of in this way, help qualify the activity impact of advances these also received cyclophosphamide (C-VAMP).made from research trials for the treatment of popuThirty-eight patients received verapamil in addition to lation-based cancer problems. C-VAMP(V-C-VAMP). After VAMP all patients wereKeywords: myeloma; induction; autologous transplanplanned to receive high-dose treatment with melphalan tation; interferon; outcome assessment; population based and an autograft (marrow or blood) and 112 received this treatment; a further 29 patients received modified high-dose treatment with melphalan alone (23) or busulfan (6) and 54 (28%) did not proceed to high-dose treatSince 1980, three important and entirely different treatment because of refusal, resistant disease, poor performments for myeloma have been developed in phase II studies ance or treatment-related death. The patients who and then been shown in controlled trials to markedly received melphalan or busulfan alone instead of highimprove outcome for selected patients with myeloma; dose melphalan/autografts did so because of increasing namely infusional induction chemotherapy, 1-3 high-dose age (P = 0.001) and a raised creatinine (P = 0.05). The consolidation chemotherapy 4,5 with autologous bone marcomplete remission rate was 53% for the whole group row rescue, 6,7 and maintenance interferon. 8,9 However, the and 74% for those receiving high-dose melphalan and nature of controlled trials, with strict entry criteria, usually an autograft. From July 1988, the sequential therapy requires that patients are selected, and further selection package in...

Recovery of renal function after autologous stem cell transplantation in myeloma patients with end-stage renal failure

“…Recent reports have suggested that this dose of melphalan may cause increased transplant-related morbidity in patients with renal failure; 1 previous studies have, however, indicated better progression-free and overall survival for patients treated with HDMel 200 mg/m 2 rather than a dose of 140 mg/m 2 . 8 Both our patients were therefore treated with the higher dose of HDMel. Although the tumour load appears to have satisfactorily been reduced using this regime, one patient (No.…”

Response to induction chemotherapy is not essential to obtain survival benefit from high-dose melphalan and autotransplantation in myeloma

“…The second reason may be our use of 200 mg/m 2 melphalan as the conditioning regimen -which has been shown to be the optimal regimen for treatment intensification in patients with myeloma. 4,[21][22][23] The MD Anderson group has, for the patients they have reported, usually employed regimens other than 200 mg/m 2 melphalan. 8,9 We have also used immunoelectrophoresis rather than immunofixation to define CR -which may overestimate the proportion of patients in CR.…”

“…5 Amongst hematologic malignancies treated with autotransplantation, 6 myeloma is unique in that autografts are performed in a substantial proportion of patients before they have attained complete remission (CR) -and most patients attaining CR do so as a result of the transplant. 4,7 Patients with primary refractory myeloma -disease that does not respond adequately to induction chemotherapyhave a poor prognosis with short survival. Dose-intensive therapy has been shown to improve the outcome of these patients in comparison with those treated conventionally.…”

Acute lymphoblastic leukaemia-type intensive chemotherapy to eliminate minimal residual disease after high-dose melphalan and autologous transplantation in multiple myeloma – a phase I/II feasibility and tolerance study of 17 patients

“…Three of these patients (Nos 6, 11, 13) had minor treatment prior to embarking on the total therapy (see Table 1). For all 17 patients receiving total therapy the median number of courses of C-VAMPs was 6 (range [4][5][6][7][8]. The response to this initial infusional chemotherapy was two CR (11.7%), one non-responder (5.9%) and all the rest attained PR (82.4%).…”

“…5 More recently, patients have also been shown to obtain survival benefit if after this intensive treatment they are then given long-term maintenance interferon (IFN). 6 All this treatment together 7,8 results in high complete remission (CR) rates of greater than 50% for new unselected patients, with a median overall survival of 4.5 years. For those who are in CR and received IFN a median overall survival has not yet been reached after more than 8 years.…”