title: Single versus double autologous stem-cell transplantation for multiple myeloma.
abstract: BACKGROUND
  We conducted a randomized trial of the treatment of multiple myeloma with high-dose chemotherapy followed by either one or two successive autologous stem-cell transplantations.
  
  
  METHODS
  At the time of diagnosis, 399 previously untreated patients under the age of 60 years were randomly assigned to receive a single or double transplant.
  
  
  RESULTS
  A complete or a very good partial response was achieved by 42 percent of patients in the single-transplant group and 50 percent of patients in the double-transplant group (P=0.10). The probability of surviving event-free for seven years after the diagnosis was 10 percent in the single-transplant group and 20 percent in the double-transplant group (P=0.03). The estimated overall seven-year survival rate was 21 percent in the single-transplant group and 42 percent in the double-transplant group (P=0.01). Among patients who did not have a very good partial response within three months after one transplantation, the probability of surviving seven years was 11 percent in the single-transplant group and 43 percent in the double-transplant group (P<0.001). Four factors were significantly related to survival: base-line serum levels of beta2-microglobulin (P<0.01) and lactate dehydrogenase (P<0.01), age (P<0.05), and treatment group (P<0.01).
  
  
  CONCLUSIONS
  As compared with a single autologous stem-cell transplantation after high-dose chemotherapy, double transplantation improves overall survival among patients with myeloma, especially those who do not have a very good partial response after undergoing one transplantation.
authors.affiliation: Department of Hematology and Biostatistics, Hôpital Purpan, Toulouse, France. attal.m@chu-toulouse.fr
authors.forename: Michel
authors.initials: M
authors.lastname: Attal
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Harousseau
authors.forename: Thierry
authors.initials: T
authors.lastname: Facon
authors.forename: François
authors.initials: F
authors.lastname: Guilhot
authors.forename: Chantal
authors.initials: C
authors.lastname: Doyen
authors.forename: Jean-Gabriel
authors.initials: JG
authors.lastname: Fuzibet
authors.forename: Mathieu
authors.initials: M
authors.lastname: Monconduit
authors.forename: Cyrille
authors.initials: C
authors.lastname: Hulin
authors.forename: Denis
authors.initials: D
authors.lastname: Caillot
authors.forename: Reda
authors.initials: R
authors.lastname: Bouabdallah
authors.forename: Laurent
authors.initials: L
authors.lastname: Voillat
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Sotto
authors.forename: Bernard
authors.initials: B
authors.lastname: Grosbois
authors.forename: Regis
authors.initials: R
authors.lastname: Bataille
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin