title: Long-term outcome results of the first tandem autotransplant trial for multiple myeloma.
abstract: Total Therapy 1, the first tandem autotransplant trial for newly diagnosed patients with multiple myeloma, was designed to increase the frequency of complete response (CR) and thereby extend survival. With a median follow-up of 12 years, 62 of 231 initially enrolled patients are alive (17% at 15 years); 31 remain event free (7% at 15 years) including 16 of 94 (41%) that initially achieved CR. Currently alive patients less frequently had cytogenetic abnormalities (CAs) at baseline (P = 0.002), postenrolment (P < 0.001) and at relapse (P = 0.004); elevations of serum C-reactive protein (CRP) (P = 0.003) and lactate dehydrogenase (P = 0.029), anaemia (P = 0.029) and they more often completed two transplants within 12 months (P = 0.019). Postenrolment overall survival (OS) and event-free survival (EFS) were superior in the absence of CA of the hypodiploidy or deletion 13 variety (P < 0.001 and 0.037 respectively) and in the presence of low CRP at baseline (P = 0.001 and 0.017 respectively). Postrelapse survival was longer in the absence of CA at relapse (P < 0.001), IgA isotype (P = 0.002), International Staging System stage 3 (P = 0.014), and when patients had two protocol transplants prior to relapse (P = 0.038). Ten-year EFS and OS could be accomplished in 15% and 33% of patients, respectively, when all agents available in 1989, especially high-dose melphalan, were applied together upfront for the management of myeloma.
authors.affiliation: Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA. BarlogieBart@unams.edu
authors.forename: Bart
authors.initials: B
authors.lastname: Barlogie
authors.forename: Guido J
authors.initials: GJ
authors.lastname: Tricot
authors.forename: Frits
authors.initials: F
authors.lastname: van Rhee
authors.forename: Edguardo
authors.initials: E
authors.lastname: Angtuaco
authors.forename: Ron
authors.initials: R
authors.lastname: Walker
authors.forename: Joshua
authors.initials: J
authors.lastname: Epstein
authors.forename: John D
authors.initials: JD
authors.lastname: Shaughnessy
authors.forename: Sundar
authors.initials: S
authors.lastname: Jagannath
authors.forename: Vanessa
authors.initials: V
authors.lastname: Bolejack
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gurley
authors.forename: Antje
authors.initials: A
authors.lastname: Hoering
authors.forename: David
authors.initials: D
authors.lastname: Vesole
authors.forename: Raman
authors.initials: R
authors.lastname: Desikan
authors.forename: David
authors.initials: D
authors.lastname: Siegel
authors.forename: Jayesh
authors.initials: J
authors.lastname: Mehta
authors.forename: Seema
authors.initials: S
authors.lastname: Singhal
authors.forename: Nikhil C
authors.initials: NC
authors.lastname: Munshi
authors.forename: Madhav
authors.initials: M
authors.lastname: Dhodapkar
authors.forename: Bonnie
authors.initials: B
authors.lastname: Jenkins
authors.forename: Michel
authors.initials: M
authors.lastname: Attal
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Harousseau
authors.forename: John
authors.initials: J
authors.lastname: Crowley
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018450:Disease Progression; D004334:Drug Administration Schedule; D004812:Epidemiologic Methods; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D008558:Melphalan