title: Matched-pair analysis to compare the outcomes of a second salvage auto-SCT to systemic chemotherapy alone in patients with multiple myeloma who relapsed after front-line auto-SCT.
abstract: The aims of this study were to investigate the outcomes of second salvage auto-SCT and to identify the impacts of a second auto-SCT compared with systemic chemotherapy alone on disease outcome. Data from 48 patients who underwent second auto-SCT were matched to 144 patients (1:3) who received systemic chemotherapy alone from the Korean Myeloma Registry. Groups were matched for nine potential prognostic factors and compared for treatment outcomes. The median age of matching-pairs at relapse was 55.5 years. A total of 156 patients (81%) received vincristine, doxorubicin and dexamethasone induction therapy before the first auto-SCT. Thirty-five patients (73%) in the second auto-SCT group received novel agent-based therapies before the second auto-SCT, and similar proportion in both groups received novel therapies after relapse of front-line auto-SCT. With a median follow-up of 55.3 months, patients who underwent a second auto-SCT had significantly better median OS (55.5 vs 25.4 months, P=0.035). In multivariate analysis for OS, <18 months time to progression after first auto-SCT, International Staging System III and salvage chemotherapy alone were independent predictors for worse OS. The outcomes of second auto-SCT appear to be superior to those of systemic chemotherapy alone. A randomized trial comparing both treatment strategies is required.
authors.affiliation: Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.
authors.forename: H-Y
authors.initials: HY
authors.lastname: Yhim
authors.forename: K
authors.initials: K
authors.lastname: Kim
authors.forename: J S
authors.initials: JS
authors.lastname: Kim
authors.forename: H J
authors.initials: HJ
authors.lastname: Kang
authors.forename: J-A
authors.initials: JA
authors.lastname: Kim
authors.forename: C-K
authors.initials: CK
authors.lastname: Min
authors.forename: S H
authors.initials: SH
authors.lastname: Bae
authors.forename: E
authors.initials: E
authors.lastname: Park
authors.forename: D-H
authors.initials: DH
authors.lastname: Yang
authors.forename: C
authors.initials: C
authors.lastname: Suh
authors.forename: M K
authors.initials: MK
authors.lastname: Kim
authors.forename: Y-C
authors.initials: YC
authors.lastname: Mun
authors.forename: H S
authors.initials: HS
authors.lastname: Eom
authors.forename: H J
authors.initials: HJ
authors.lastname: Shin
authors.forename: H-J
authors.initials: HJ
authors.lastname: Yoon
authors.forename: J H
authors.initials: JH
authors.lastname: Kwon
authors.forename: J H
authors.initials: JH
authors.lastname: Lee
authors.forename: Y S
authors.initials: YS
authors.lastname: Kim
authors.forename: S-S
authors.initials: SS
authors.lastname: Yoon
authors.forename: J-Y
authors.initials: JY
authors.lastname: Kwak
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000601:surgery*; D016879:Salvage Therapy; D033581:Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin