title: 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 Osea phase II trial.
abstract: 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/m2 (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 = 0.00001), 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.
authors.affiliation: Hematology Departments of Hospital Universitario 12 de Octubre, Madrid, Spain. jjlahuerta@terra.es
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Lahuerta
authors.forename: Carlos
authors.initials: C
authors.lastname: Grande
authors.forename: Joaquín
authors.initials: J
authors.lastname: Martínez-Lopez
authors.forename: Javier
authors.initials: J
authors.lastname: De La Serna
authors.forename: Rosa
authors.initials: R
authors.lastname: Toscano
authors.forename: María Cruz
authors.initials: MC
authors.lastname: Ortiz
authors.forename: Santiago
authors.initials: S
authors.lastname: Larregla
authors.forename: Eulogio
authors.initials: E
authors.lastname: Conde
authors.forename: Andrés
authors.initials: A
authors.lastname: Insunza
authors.forename: José David
authors.initials: JD
authors.lastname: Gonzalez-San Miguel
authors.forename: Juan
authors.initials: J
authors.lastname: Bargay
authors.forename: Rafael
authors.initials: R
authors.lastname: Cabrera
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: García-Ruiz
authors.forename: Carmen
authors.initials: C
authors.lastname: Albó
authors.forename: Luis
authors.initials: L
authors.lastname: García-Alonso
authors.forename: Fernando
authors.initials: F
authors.lastname: Solano
authors.forename: Pilar
authors.initials: P
authors.lastname: Vivancos
authors.forename: Angel
authors.initials: A
authors.lastname: León
authors.forename: Jesús
authors.initials: J
authors.lastname: San Miguel
mesh_terms: D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation; D033581:Stem Cell Transplantation / Q000379:methods*; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods; D014182:Transplantation, Autologous; D016896:Treatment Outcome