title: Intensive therapy for multiple myeloma in patients younger than 60 years. Long-term results focusing on the effect of the degree of response on survival and relapse pattern after transplantation.
abstract: OBJECTIVE
  From 1994 to 1997 we conducted a population-based, prospective study on intensive therapy in newly diagnosed symptomatic myeloma patients younger than 60 years, comparing their survival to that of a conventionally treated historic population. Long-term results are presented, including the impact of the degree of response on survival and relapse pattern after transplantation.
  
  
  METHODS
  The prospective population was formed of 397 patients and the historic population of 313 patients. Both populations were calculated to comprise more than 75% of the expected number of new cases.
  
  
  RESULTS
  After a median follow-up of 7 years survival was longer in the prospective population than in the historic one (median 60 versus 39 months; p=0.0002). When comparing only patients eligible for intensive therapy the median survival was 63 versus 44 months (p<0.0001). Attaining a complete response was associated with prolonged event-free survival but not overall survival. The pattern of relapse after transplantation was heterogeneous but could be divided into four major groups; insidious, classical, plasmacytoma form and transformed disease. The median survival after relapse was 29 months. The relapse pattern and time to relapse predicted outcome. Patients relapsing with an insidious or classical form of disease with skeletal events only, or after a long lasting first response were likely to respond well to conventional salvage therapy. In contrast, relapse with multiple symptoms, transformed disease or a short duration of first response implied bad prognosis.
  
  
  CONCLUSIONS
  The relapse pattern after autologous transplantation is heterogeneous and response to salvage therapy is variable. The degree of response and event-free survival after transplantation are not reliable surrogate markers for survival.
authors.affiliation: Department of Hematology, University Hospital, S-221 85 Lund, Sweden. Stig.Lenhoff@skane.se
authors.forename: Stig
authors.initials: S
authors.lastname: Lenhoff
authors.forename: Martin
authors.initials: M
authors.lastname: Hjorth
authors.forename: Ingemar
authors.initials: I
authors.lastname: Turesson
authors.forename: Jan
authors.initials: J
authors.lastname: Westin
authors.forename: Peter
authors.initials: P
authors.lastname: Gimsing
authors.forename: Finn
authors.initials: F
authors.lastname: Wislöff
authors.forename: Lucia
authors.initials: L
authors.lastname: Ahlberg
authors.forename: Kristina
authors.initials: K
authors.lastname: Carlson
authors.forename: Ilse
authors.initials: I
authors.lastname: Christiansen
authors.forename: Inger Marie
authors.initials: IM
authors.lastname: Dahl
authors.forename: Karin
authors.initials: K
authors.lastname: Forsberg
authors.forename: Lorentz
authors.initials: L
authors.lastname: Brinch
authors.forename: Jens
authors.initials: J
authors.lastname: Hammerström
authors.forename: Hans E
authors.initials: HE
authors.lastname: Johnsen
authors.forename: Lene Meldgaard
authors.initials: LM
authors.lastname: Knudsen
authors.forename: Olle
authors.initials: O
authors.lastname: Linder
authors.forename: Ulf-Henrik
authors.initials: UH
authors.lastname: Mellqvist
authors.forename: Ingerid
authors.initials: I
authors.lastname: Nesthus
authors.forename: Johan Lanng
authors.initials: JL
authors.lastname: Nielsen
mesh_terms: D000328:Adult; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality / Q000628:therapy*; D016879:Salvage Therapy; D015996:Survival Rate; D014182:Transplantation, Autologous; D016896:Treatment Outcome