title: Long-term outcomes of autologous transplantation in multiple myeloma: significant survival benefit of novel drugs in post-transplantation relapse.
abstract: BACKGROUND
  Autologous stem cell transplantation (autoSCT) has an important role in the treatment of patients with symptomatic multiple myeloma (MM). Treatment options for myeloma have expanded in the past decade, and it seems that patients who are treated with novel drugs such as thalidomide and bortezomib for relapse after autoSCT have longer overall survival (OS).
  
  
  METHODS
  Herein, we describe the long-term outcome of a cohort of 185 patients with newly diagnosed MM treated with autoSCT. We have analyzed factors that might predict for long-term survival.
  
  
  RESULTS
  Following autoSCT, the overall response rate was 94% (173 of 185 patients); 29% (53 of 185 patients) were in complete remission (CR). Median time to progression (TTP) and OS from start of therapy were 39.8 months and 77.9 months, respectively. The median follow-up was 103.8 months (range, 60.8-144.8 months); 23% of the patients are alive and disease free, 21% of the patients are alive with relapse, and 56% of the patients have died. On multivariate analysis, factors associated with significantly better OS were International Staging System (ISS) disease stage < III (hazard ratio [HR], 2.6; P < .001), achievement of CR after autoSCT (HR, 2.8; P < .001) and use of thalidomide (HR, 4.3; P < .001) and/or bortezomib (HR, 7.3; P < .001) in posttransplantation relapse treatment. The patients' age, renal impairment, disease status before autoSCT and maintenance therapy with interferon-alpha (IFN-alpha) or IFN-alpha and dexamethasone did not significantly affect TTP and OS after transplantation.
  
  
  CONCLUSIONS
  According to our results, the achievement of CR after transplantation, ISS stage other than III, and administration of thalidomide or bortezomib in posttransplantation relapse were significant parameters favoring long-term posttransplantation survival.
authors: Department of Internal Medicine - Hematooncology, Masaryk University Hospital, Jihlavska 20, 625 00 Brno, Czech Republic. mkrejci@fnbrno.cz
authors: Marta
authors: M
authors: Krejci
authors: Vlastimil
authors: V
authors: Scudla
authors: Elen
authors: E
authors: Tothova
authors: Miroslava
authors: M
authors: Schutzova
authors: Vladimir
authors: V
authors: Koza
authors: Zdenek
authors: Z
authors: Adam
authors: Andrea
authors: A
authors: Krivanova
authors: Ludek
authors: L
authors: Pour
authors: Tomas
authors: T
authors: Buchler
authors: Viera
authors: V
authors: Sandecka
authors: Dana
authors: D
authors: Kralova
authors: Lenka
authors: L
authors: Zahradova
authors: Jiri
authors: J
authors: Vorlicek
authors: Jiri
authors: J
authors: Mayer
authors: Roman
authors: R
authors: Hajek
mesh_terms: D000328:Adult; D000368:Aged; D001897:Boronic Acids / Q000627:therapeutic use*; D000069286:Bortezomib; D018450:Disease Progression; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality / Q000628:therapy*; D011719:Pyrazines / Q000627:therapeutic use*; D012008:Recurrence; D013792:Thalidomide / Q000627:therapeutic use*; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D001897:Boronic Acids; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib