title: Benefit from autologous stem cell transplantation in primary refractory myeloma? Different outcomes in progressive versus stable disease.
abstract: BACKGROUND
  Several studies of autologous stem cell transplantation in primary refractory myeloma have produced encouraging results. However, the outcome of primary refractory patients with stable disease has not been analyzed separately from the outcome of patients with progressive disease.
  
  
  METHODS
  In the Spanish Myeloma Group 2000 trial, 80 patients with primary refractory myeloma (49 with stable disease and 31 with progressive disease), i.e. who were refractory to initial chemotherapy, were scheduled for tandem transplants (double autologous transplant or a single autologous transplant followed by an allogeneic transplant). Patients with primary refractory disease included those who never achieved a minimal response (≥ 25% M-protein decrease) or better. Responses were assessed using the European Bone Marrow Transplant criteria.
  
  
  RESULTS
  There were no significant differences in the rates of partial response or better between patients with stable or progressive disease. However, 38% of the patients with stable disease at the time of transplantation remained in a stable condition or achieved a minimal response after transplantation versus 7% in the group with progressive disease (P=0.0017) and the rate of early progression after transplantation was significantly higher among the group with progressive disease at the time of transplantation (22% versus 2%; P=0.0043). After a median follow-up of 6.6 years, the median survival after first transplant of the whole series was 2.3 years. Progression-free and overall survival from the first transplant were shorter in patients with progressive disease (0.6 versus 2.3 years, P=0.00004 and 1.1 versus 6 years, P=0.00002, respectively).
  
  
  CONCLUSIONS
  Our results show that patients with progressive refractory myeloma do not benefit from autologous transplantation, while patients with stable disease have an outcome comparable to those with chemosensitive disease.
authors: Hospital Clínic, Villarroel, 170, 08036 Barcelona, Spain.
authors: Laura
authors: L
authors: Rosiñol
authors: Ramón
authors: R
authors: García-Sanz
authors: Juan José
authors: JJ
authors: Lahuerta
authors: Miguel
authors: M
authors: Hernández-García
authors: Miquel
authors: M
authors: Granell
authors: Javier
authors: J
authors: de la Rubia
authors: Albert
authors: A
authors: Oriol
authors: Belén
authors: B
authors: Hernández-Ruiz
authors: Consuelo
authors: C
authors: Rayón
authors: Isabel
authors: I
authors: Navarro
authors: Juan Carlos
authors: JC
authors: García-Ruiz
authors: Joan
authors: J
authors: Besalduch
authors: Santiago
authors: S
authors: Gardella
authors: Javier
authors: J
authors: López Jiménez
authors: Joaquín
authors: J
authors: Díaz-Mediavilla
authors: Adrián
authors: A
authors: Alegre
authors: Jesús
authors: J
authors: San Miguel
authors: Joan
authors: J
authors: Bladé
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome