title: Durable remission with salvage second autotransplants in patients with multiple myeloma.
abstract: BACKGROUND
  High-dose chemotherapy with autologous hematopoietic cell transplant (auto-HCT) has been shown to improve survival in patients with newly diagnosed multiple myeloma. However, the role of salvage auto-HCT for relapsed patients, particularly in the era of novel therapeutics, is not well defined.
  
  
  METHODS
  The authors performed a retrospective analysis of all 44 myeloma patients (24 men, 20 women) who received a second auto-HCT as salvage between January 3, 1992 and November 4, 2008 at The University of Texas MD Anderson Cancer Center.
  
  
  RESULTS
  Median interval between the first and salvage auto-HCT was 30 months (range, 2-78 months). Median age at salvage HCT was 54 years (range, 38-73 years), and median number of salvage treatment regimens was 2 (range, 0-5). Eleven (25%) patients had high-risk chromosomal abnormalities on conventional cytogenetic studies between diagnosis and salvage auto-HCT. Ten patients (23%) experienced grade 3 or higher nonhematologic toxicity after the salvage auto-HCT. One patient died within 100 days, for a treatment-related mortality of 2%. Best responses after salvage chemotherapy + salvage auto-HCT were as follows: complete response (CR) + near CR, 11%; partial response, 79%; overall response rate, 90%. Eighteen (41%) patients received post auto-HCT maintenance therapy. Median follow-up from salvage HCT was 41 months. Kaplan-Meier estimates of median progression-free survival (PFS) and overall survival (OS) from time of salvage auto-HCT were 12.3 and 31.7 months, respectively. Median OS from the time of diagnosis was 75 months. In a fitted Bayesian multivariate model, shorter time to progression after first auto-HCT, greater number of prior therapies, African American race, and immunoglobulin G subtype were significantly associated with worse OS.
  
  
  CONCLUSIONS
  In selected myeloma patients, a second auto-HCT for salvage therapy is well tolerated, with acceptable toxicity. The overall response rate and PFS are comparable to other salvage regimens.
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. nshah@mdanderson.org
authors.forename: Nina
authors.initials: N
authors.lastname: Shah
authors.forename: Fraz
authors.initials: F
authors.lastname: Ahmed
authors.forename: Qaiser
authors.initials: Q
authors.lastname: Bashir
authors.forename: Sofia
authors.initials: S
authors.lastname: Qureshi
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Dinh
authors.forename: Gabriela
authors.initials: G
authors.lastname: Rondon
authors.forename: Sijin
authors.initials: S
authors.lastname: Wen
authors.forename: Peter
authors.initials: P
authors.lastname: Thall
authors.forename: Hassan
authors.initials: H
authors.lastname: Khan
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
authors.forename: Richard
authors.initials: R
authors.lastname: Champlin
authors.forename: Muzaffar H
authors.initials: MH
authors.lastname: Qazilbash
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D019233:Retreatment; D016879:Salvage Therapy; D014182:Transplantation, Autologous
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