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

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/m 2 (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 ¼ 0AE00001), 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.

Clinical Features and Survival Outcomes in Patients with Multiple Myeloma: Analysis of Web-Based Data from the Korean Myeloma Registry

“…When we compared the survival of patients who underwent upfront single or tandem autologous SCT, tandem autologous SCT produced a longer OS compared with single autologous SCT (fig. 2b), also consistent with previous reports suggesting the superiority of tandem autologous SCT in MM treatment [16,17,18]. However, these data contrast with what was found in a recently published meta-analysis which showed that the use of tandem autologous SCT did not result in an improved OS in previously untreated MM patients [19].…”

A Phase I/II Trial Combining High-Dose Melphalan and Autologous Transplant with Bortezomib for Multiple Myeloma: A Dose- and Schedule-Finding Study

“…To improve the efficacy of the HDT maneuver itself, groups have explored the use of multiple cycles of HDT (tandem transplant; refs. [6][7][8], the use of combination chemotherapy conditioning regimens using agents in addition to or replacing melphalan in HDT conditioning (9)(10)(11)(12), and the addition of radiation therapy using targeted antibodies (13,14) or external beam radiation (15). Unfortunately, none of these approaches has been shown to be superior to the use of 200 mg/m 2 of melphalan.…”

Phase I/II study of tandem high-dose chemotherapy with autologous peripheral blood stem cell transplantation for advanced multiple myeloma

“…Barlogie et al [10,16] treated patients with ''Total Therapy (TT) 1,'' consisting of 2 cycles of highdose chemotherapy with tandem auto-PBSCT; they demonstrated its efficacy and safety, and achieved a high CR rate resulting in improvement of the prognosis. Tandem auto-transplantation has been reported in various countries [17][18][19]. In our protocol, as in TT 1, a VAD regimen containing no alkylating agents was used to reduce the tumor burden as induction therapy, followed by PBSC harvesting after HD-CY therapy and tandem auto-PBSCT with high-dose melphalan.…”