Survival after relapse following tandem autotransplants in multiple myeloma patients: the University of Arkansas total therapy I experience.
Despite the superiority of high-dose (compared with standard) treatment in multiple myeloma, relapses still occur. We evaluated relapse patterns, salvage treatments employed and outcome in patients given tandem transplants on our total therapy I protocol. We focused on 146 patients (of 231 enrolled) who received tandem autotransplants < or =12 months apart and survived > or =2 months after the second transplant. With a median follow-up of 9 years after enrollment, 31 (21%) patients remain in complete or stable partial remission. Ninety-five (65%) patients received therapy for relapsing myeloma. The median time from the first transplant to relapse was 2.9 years. The median overall survival from relapse was 2.4 years. In one-quarter (23/95) of cases, the postrelapse interval exceeded the interval from the first transplant to relapse. On multivariate analysis, the presence of any cytogenetic abnormalities [P<0.001, Hazard Ratio (HR): 3.84] and beta-2 microglobulin levels >4 mg/l at relapse (P<0.001, HR: 2.87) were significant for poor survival after relapse. The median survival after relapse was 5.1, 1.3 and 0.7 years in patients with none (44%), one (46%) and two (10%) poor-risk factors, respectively. In conclusion, a sizeable fraction of myeloma patients relapsing after tandem autotransplants without poor-risk features enjoyed meaningful survival prolongation when appropriately treated.
Fassas
Athanasios B-T
AB
Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA. FassasAthanasios@uams.edu
Barlogie
Bart
B
Ward
Susan
S
Jagannath
Sundar
S
Vesole
David
D
Mattox
Sandy
S
Siegel
David
D
Muwalla
Firas
F
Zangari
Maurizio
M
Anaissie
Elias
E
Rhee
Frits Van
FV
Thertulien
Raymond
R
Lee
Choon-Kee
CK
Desikan
Raman
R
Arzumanian
Varant
V
McCoy
Jason
J
Tricot
Guido
G
D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009101:Multiple Myeloma / Q000401:mortality* / Q000601:surgery*; D015999:Multivariate Analysis; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy; D033581:Stem Cell Transplantation; D015996:Survival Rate; D014182:Transplantation, Autologous