title: Long-term results in multiple myeloma after high-dose melphalan and autologous transplantation according to response categories in the era of old drugs.
abstract: BACKGROUND
  The aim of this study was to investigate the correlation between the long-term prognosis of multiple myeloma (MM) and the quality of response to therapy in a cohort of 173 patients treated with high-dose melphalan (HDM) and autologous transplantation in the era of old drugs.
  
  
  METHODS
  A total of 173 patients with de novo MM who received a transplant between 1994 and 2010 were analyzed. VAD (vincristine, doxorubicin [Adriamycin], dexamethasone) was used as front-line regimen before auto-HPCT. The conditioning was HDM 200 mg/m(2). Patients were evaluated for clinical response using the criteria from the European Group for Blood and Marrow Transplantation, modified to include near complete remission (nCR) and very good partial remission (VGPR).
  
  
  RESULTS
  The response distribution after transplantation in our series was complete remission (CR) in 33 cases (19%), nearly complete remission (nCR) in 38 cases (22%), VGPR in 30 cases (17%), partial remission (PR) in 65 cases (38%), and stable disease (SD) in 7 cases (4%). Patients were followed for 48 ± 36 months. Median overall survival (OS) was not reached for the CR group. Progression-free survival (PFS) was 122 months for CR, 55 months for nCR, 56 months for VGPR, 32 months for PR, and 22 months for SD. Significant differences in PFS and OS were found between the CR and nCR groups (P = .003 and P = .001, respectively), between the CR and VGPR groups (P = .002 and P = .001, respectively), and between the CR and PR groups (P = .000 and P = .001, respectively). Responses were clustered in 3 main categories, ie, CR, nCR + VGPR + PR, and SD. The respective 10-year PFS and OS values were 58% and 70% for CR, 15% and 18% for nCR + VGPR + PR, and 0% and 0% for SD.
  
  
  CONCLUSIONS
  The achievement of depth and prolonged response represents the most important prognostic factor. The relapse rate is low for patients in CR after 10 years of follow-up, possibly signifying a cure.
authors.affiliation: Hematology and Transplant Unit, Azienda Ospedaliera BMM, Reggio Calabria, Italy. Electronic address: dr.massimomartino@gmail.com.
authors.forename: Massimo
authors.initials: M
authors.lastname: Martino
authors.affiliation: The National Research Council (CNR), Reggio Calabria, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Postorino
authors.affiliation: Hematology and Transplant Unit, Azienda Ospedaliera BMM, Reggio Calabria, Italy.
authors.forename: Giuseppe Alberto
authors.initials: GA
authors.lastname: Gallo
authors.affiliation: Hematology and Transplant Unit, Azienda Ospedaliera BMM, Reggio Calabria, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Messina
authors.affiliation: Hematology Unit, Azienda Ospedaliera Papardo, Messina, Italy.
authors.forename: Santo
authors.initials: S
authors.lastname: Neri
authors.affiliation: Hematology Unit, Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Piro
authors.affiliation: Hematology Unit, Azienda Ospedaliera dell'Annunziata, Cosenza, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Gentile
authors.affiliation: Hematology and Transplant Unit, Azienda Ospedaliera BMM, Reggio Calabria, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Moscato
authors.affiliation: Hematology and Transplant Unit, Azienda Ospedaliera BMM, Reggio Calabria, Italy.
authors.forename: Renza
authors.initials: R
authors.lastname: Monteleone
authors.affiliation: Hematology and Transplant Unit, Azienda Ospedaliera BMM, Reggio Calabria, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Fedele
authors.affiliation: Hematology Unit, Azienda Ospedaliera dell'Annunziata, Cosenza, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Mazzone
authors.affiliation: Hematology and Transplant Unit, Azienda Ospedaliera BMM, Reggio Calabria, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Console
authors.affiliation: Hematology Unit, Azienda Ospedaliera, Policlinico Universitario, Messina, Italy.
authors.forename: Giuseppa
authors.initials: G
authors.lastname: Penna
authors.affiliation: Hematology Unit, Azienda Ospedaliera BMM, Reggio Calabria, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Alati
authors.affiliation: Hematology Unit, Azienda Ospedaliera BMM, Reggio Calabria, Italy.
authors.forename: Iolanda Donatella
authors.initials: ID
authors.lastname: Vincelli
authors.affiliation: Hematology and Transplant Unit, Azienda Ospedaliera BMM, Reggio Calabria, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Irrera
authors.affiliation: Hematology Unit, Azienda Ospedaliera, Policlinico Universitario, Messina, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Musolino
authors.affiliation: Hematology Unit, Azienda Ospedaliera BMM, Reggio Calabria, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ronco
authors.affiliation: Hematology Unit, Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Molica
authors.affiliation: Hematology Unit, Azienda Ospedaliera dell'Annunziata, Cosenza, Italy.
authors.forename: Fortunato
authors.initials: F
authors.lastname: Morabito
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008558:Melphalan / Q000627:therapeutic use*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy*; D011379:Prognosis; D012074:Remission Induction; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D008558:Melphalan
keywords: Autologous transplantation; High-dose melphalan; Long-term results; Multiple myeloma