Long-term outcome results of the first tandem autotransplant trial for multiple myeloma.
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.
Barlogie
Bart
B
Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA. BarlogieBart@unams.edu
Tricot
Guido J
GJ
van Rhee
Frits
F
Angtuaco
Edguardo
E
Walker
Ron
R
Epstein
Joshua
J
Shaughnessy
John D
JD
Jagannath
Sundar
S
Bolejack
Vanessa
V
Gurley
Jennifer
J
Hoering
Antje
A
Vesole
David
D
Desikan
Raman
R
Siegel
David
D
Mehta
Jayesh
J
Singhal
Seema
S
Munshi
Nikhil C
NC
Dhodapkar
Madhav
M
Jenkins
Bonnie
B
Attal
Michel
M
Harousseau
Jean-Luc
JL
Crowley
John
J
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
D008558:Melphalan