title: An incremental response to high-dose therapy in multiple myeloma.
abstract: Results of conventional chemotherapy for multiple myeloma are disappointing. High-dose chemoradiotherapy with auto-transplantation is increasingly reported and some results are encouraging. We report the results of peripheral blood stem cell transplantation (PBSCT) for multiple myeloma at a single institution over a 6-year period. Forty patients, including 18 de novo patients, received debulking chemotherapy consisting of vincristine, adriamycin, and dexamethasone or methyl-prednisolone followed by stem cell mobilization with high-dose cyclophosphamide. Twenty-nine patients received PBSCT following high-dose chemoradiotherapy. Following PBSCT 92% of evaluable patients obtained at least a partial remission and 29% reached complete remission. Objective treatment responses, defined as at least a 50% reduction in serum paraprotein or marrow plasma cells, were observed following each treatment step of debulking chemotherapy, mobilization and PBSCT in 50, 42 and 71% of patients, respectively. The median overall survival from diagnosis in patients transplanted was 50 months and the median overall and progression-free survivals following transplant were 26 and 18 months, respectively. Median follow-up was 28 months. Overall treatment-related mortality was 20% but was significantly lower in de novo vs previously treated patients at 6 and 33% respectively (P = 0.027). De novo patients were more likely to obtain complete remission and had a longer overall survival following transplant but overall survival from diagnosis was similar to previously treated patients. A low serum B2M before mobilization predicted a longer progression-free survival. PBSCT needs to be considered early following diagnosis to maximise treatment response and reduce the high treatment-related mortality seen in heavily pretreated patients. In this treatment program a dose response effect in multiple myeloma was observed possibly suggesting that more intensive therapy than a single transplant may effect greater disease response.
authors.affiliation: Hanson Centre for Cancer Research, Institute of Medical and Veterinary Science, Adelaide, SA, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Hawkins
authors.forename: N
authors.initials: N
authors.lastname: Horvath
authors.forename: C
authors.initials: C
authors.lastname: Rawling
authors.forename: J
authors.initials: J
authors.lastname: Bayly
authors.forename: C
authors.initials: C
authors.lastname: Andary
authors.forename: P
authors.initials: P
authors.lastname: Dyson
authors.forename: J
authors.initials: J
authors.lastname: Ho
authors.forename: G
authors.initials: G
authors.lastname: Dart
authors.forename: C
authors.initials: C
authors.lastname: Juttner
authors.forename: B
authors.initials: B
authors.lastname: To
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D015996:Survival Rate