title: Transplantation as salvage therapy for high-risk patients with myeloma in relapse.
abstract: Patients with myeloma relapsing after tandem transplant have a poor survival and treatment options are limited. The role of additional salvage transplant procedures for these patients is unknown. To evaluate the benefit and identify prognostic factors, the outcome of 76 consecutive patients with recurrent myeloma after tandem transplant receiving salvage transplants (ST) was analyzed. Prior to ST, 23 patients (30%) had shown chemosensitive response to preceding salvage chemotherapy: two complete remissions (CR); eight near CRs (nCR: only immunofixation positive); 13 partial remissions (PR >or=75% reduction in M protein). Fifty received an autologous transplant, 22 a sibling-matched allogeneic transplant, and four a matched-unrelated allogeneic transplant. Overall response after ST was 59%: eight CRs (11%); 14 nCRs (18%); 23 PRs (30%). Overall survival (OS) at 2 years was 19%; 2 year event-free survival rate (EFS) 7%. On univariate analysis for survival, only pre-transplant chemosensitive relapse (P < 0.05), serum albumin >3 g/dl (P = 0.001), normal LDH (P = 0.04), and long interval between the second transplant and relapse/progression were significant beneficial factors. In a Cox proportional hazard model, chemosensitive relapse, and albumin >3 g/dl were significant for better OS: hazard ratio (HR) 1.4, 1.7, respectively, while normal LDH, and absence of CA13 were significant for better EFS: HR 1.8, 1.7, respectively. Patients with albumin >3 g/dl who had chemosensitive disease before ST (n = 16) had a median survival of 16 months, compared to 7 months (n = 34) and 2 months (n = 26) for patients with only one (n = 34) or no favorable prognostic factors (n = 28), respectively (P < 0.001). Their survival at 2 years post-ST was 43%, 17% and 11%, respectively. Our study suggests further transplantation should only be considered in the setting of a clinical trial in patients with favorable prognostic factors.
authors.affiliation: The Myeloma Institute for Research and Therapy, The University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
authors.forename: C-K
authors.initials: CK
authors.lastname: Lee
authors.forename: B
authors.initials: B
authors.lastname: Barlogie
authors.forename: M
authors.initials: M
authors.lastname: Zangari
authors.forename: A
authors.initials: A
authors.lastname: Fassas
authors.forename: E
authors.initials: E
authors.lastname: Anaissie
authors.forename: C
authors.initials: C
authors.lastname: Morris
authors.forename: F
authors.initials: F
authors.lastname: Van Rhee
authors.forename: M
authors.initials: M
authors.lastname: Cottler-Fox
authors.forename: R
authors.initials: R
authors.lastname: Thertulien
authors.forename: F
authors.initials: F
authors.lastname: Muwalla
authors.forename: S
authors.initials: S
authors.lastname: Mazher
authors.forename: A
authors.initials: A
authors.lastname: Badros
authors.forename: G
authors.initials: G
authors.lastname: Tricot
mesh_terms: D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000401:mortality; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000008:administration & dosage; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm; D005260:Female; D006085:Graft Survival; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000628:therapy*; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D009364:Neoplasm Recurrence, Local; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D011379:Prognosis; D012074:Remission Induction; D016879:Salvage Therapy; D018805:Sepsis / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis; D013792:Thalidomide / Q000008:administration & dosage / Q000627:therapeutic use; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000401:mortality; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D013792:Thalidomide; D003907:Dexamethasone