title: An elective single autograft with high-dose melphalan: single-center study of 451 patients.
abstract: In all, 451 myeloma patients, 51% previously untreated, underwent elective single autotransplantation after 200 mg/m(2) melphalan between 1985 and 2001 at the Royal Marsden Hospital. The therapy sequence was: Induction (vincristine, doxorubicin, methylprednisolone+/-cyclophosphamide), marrow or filgrastim-mobilized blood stem cell harvest, autograft, and interferon-alpha2b maintenance. A total of 27 (6%) died of transplant-related toxicity, all within 3 months. Complete or near-complete remission was seen in 59% with an overall response rate of 91%. Subsequent disease progression was seen in 285, and 17 died of unrelated causes. In all, 206 patients were alive at the last follow-up, 6 months to 17.7 years post-transplant (median 65 months); 122 without disease progression at 6 months to 17.7 years (median 58 months). The median overall (OS) and event-free (EFS) survivals were 5.9 and 2.4 years, with 10-year OS and EFS probabilities of 31.4 and 16.5%, respectively. In Cox analysis, it was seen that significantly longer OS occurred for patients who had beta-2-microglobulin <3.5 mg/l (P<0.0001), age <60 years (P=0.001) and albumin > or =35 g/l (P=0.009). EFS was also longer if beta-2-microglobulin was <3.5 mg/l (P=0.0056) and patients were <60 years of age (P=0.033). We conclude that with a single planned autograft, patients with myeloma have an excellent outcome.
authors.affiliation: Leukaemia and Myeloma Units, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK. Bhawna.sirohi@rmh.nhs.uk
authors.forename: B
authors.initials: B
authors.lastname: Sirohi
authors.forename: R
authors.initials: R
authors.lastname: Powles
authors.forename: J
authors.initials: J
authors.lastname: Mehta
authors.forename: C
authors.initials: C
authors.lastname: Rudin
authors.forename: S
authors.initials: S
authors.lastname: Kulkarni
authors.forename: C
authors.initials: C
authors.lastname: Horton
authors.forename: R
authors.initials: R
authors.lastname: Saso
authors.forename: S
authors.initials: S
authors.lastname: Singhal
authors.forename: J
authors.initials: J
authors.lastname: Treleaven
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007937:Leukapheresis; D008297:Male; D008558:Melphalan / Q000008:administration & dosage*; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D012074:Remission Induction / Q000379:methods; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D008558:Melphalan