title: High-dose therapy followed by autologous hematopoietic stem-cell infusion for patients with multiple myeloma.
abstract: OBJECTIVE
  To evaluate the outcome of patients with multiple myeloma (MM) who received high-dose therapy followed by autologous bone marrow (BM) or peripheral-blood stem-cell (PBSC) infusion.
  
  
  METHODS
  Sixty-three consecutive patients with MM received autologous BM (n = 13) or PBSC with or without BM (n = 50) following regimens that contained busulfan (Bu) and cyclophosphamide (Cy) (n = 18), modified total-body irradiation (TBI) followed by Bu and Cy (n = 36), or Bu, melphalan, and thiotepa (n = 9). Two thirds of the patients had resistant disease and 69% had received more than 6 months of previous chemotherapy.
  
  
  CONCLUSIONS
  Recovery of peripheral-blood cell counts was more rapid in patients who received PBSC with or without BM than in patients who received BM alone. Sixteen of 63 patients (25%) died of complications of treatment within 100 days. Nineteen (40%) of 48 assessable patients achieved a complete response (CR), 23 (48%) had a partial response (PR), and six (12%) had no response. The probabilities of survival and survival without relapse or progression for all 63 patients at 3.0 years were .43 and .21, respectively. The probability of relapse or progression at 3 years was .69, and 17 patients (27%) have died of progressive MM. The probabilities of survival and relapse-free survival at 3 years for the 19 patients who achieved a CR were .42 and .17, respectively. In the multivariate analysis, beta2-microglobulin levels more than 2.5 micrograms/mL, more than two regimens of prior therapy and eight cycles of treatment, time to transplant longer than 3 years from diagnosis, and prior radiation were associated with adverse outcomes. Additional strategies, such as intervention earlier in the disease course, improved treatment regimens, sequential high-dose treatments, and posttransplant therapies may improve outcome of selected patients with MM.
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA 98104, USA.
authors.forename: W I
authors.initials: WI
authors.lastname: Bensinger
authors.forename: S D
authors.initials: SD
authors.lastname: Rowley
authors.forename: T
authors.initials: T
authors.lastname: Demirer
authors.forename: K
authors.initials: K
authors.lastname: Lilleby
authors.forename: K
authors.initials: K
authors.lastname: Schiffman
authors.forename: R A
authors.initials: RA
authors.lastname: Clift
authors.forename: F R
authors.initials: FR
authors.lastname: Appelbaum
authors.forename: A
authors.initials: A
authors.lastname: Fefer
authors.forename: T
authors.initials: T
authors.lastname: Barnett
authors.forename: R
authors.initials: R
authors.lastname: Storb
authors.forename: T
authors.initials: T
authors.lastname: Chauncey
authors.forename: R T
authors.initials: RT
authors.lastname: Maziarz
authors.forename: J
authors.initials: J
authors.lastname: Klarnet
authors.forename: P
authors.initials: P
authors.lastname: McSweeney
authors.forename: L
authors.initials: L
authors.lastname: Holmberg
authors.forename: D G
authors.initials: DG
authors.lastname: Maloney
authors.forename: C H
authors.initials: CH
authors.lastname: Weaver
authors.forename: C D
authors.initials: CD
authors.lastname: Buckner
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D002066:Busulfan / Q000627:therapeutic use; D002423:Cause of Death; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents; D016898:Interferon-alpha; D003520:Cyclophosphamide; D002066:Busulfan