title: Efficacy of up-front treatment with a double stem cell transplantation in multiple myeloma.
abstract: BACKGROUND
  We report the outcome of 53 patients with multiple myeloma (MM), who received autologous stem cell transplantation (ASCT) from April 1996 to September 2004 at our institution and who survived for more than 3 months after the transplant.
  
  
  METHODS
  Following the first ASCT, 36 patients underwent an up-front second SCT, which consisted of either an ASCT (n = 24) or a reduced-intensity conditioning allogeneic stem cell transplant (RIST) (n = 12). Seventeen patients were given maintenance treatment.
  
  
  RESULTS
  Seventy-seven percent of the patients (n = 41) showed an objective response to the initial therapy prior to the first ASCT. Overall, 60.4% (32 out of 53) and 32.1% (17 out of 53) of the patients had a complete response (CR) and partial response (PR) after the first ASCT, respectively. At the time of analysis, 34 patients (64.2%) were still alive. With a median follow-up of 32 months (range 9-98), the estimated progression-free survival (PFS) and overall survival (OS) at 5 years were 17.0 and 34.9%, respectively. Multivariate analysis revealed that the second SCT, normal hemoglobin and <50% marrow plasma cells were associated with an improved PFS. A second SCT, CR to the first SCT, female gender and an absence of advanced bone lesions were associated with a better OS.
  
  
  CONCLUSIONS
  A second SCT is the most significant factor for an improved PFS and OS after the first ASCT (P < 0.001, respectively). Up-front double SCT is needed to improve the OS and PFS in patients with MM.
authors.affiliation: Catholic Hematopoietic Stem Cell Transplantation Center, St Mary's Hospital, Catholic University of Korea, Youngdungpo-Gu, Seoul 150-713, South Korea.
authors.forename: Ki-Seong
authors.initials: KS
authors.lastname: Eom
authors.forename: Chang-Ki
authors.initials: CK
authors.lastname: Min
authors.forename: Seok
authors.initials: S
authors.lastname: Lee
authors.forename: Yoo-Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Sung-Yong
authors.initials: SY
authors.lastname: Kim
authors.forename: Hee-Je
authors.initials: HJ
authors.lastname: Kim
authors.forename: Jong-Wook
authors.initials: JW
authors.lastname: Lee
authors.forename: Woo-Sung
authors.initials: WS
authors.lastname: Min
authors.forename: Chun-Choo
authors.initials: CC
authors.lastname: Kim
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002423:Cause of Death; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D012074:Remission Induction; D033581:Stem Cell Transplantation / Q000379:methods*; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000379:methods; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome