title: Outcomes of autologous transplantation for multiple myeloma according to different induction regimens.
abstract: BACKGROUND
  Induction therapy followed by high-dose chemotherapy and autologous transplantation is the standard treatment for suitable patients with multiple myeloma.
  
  
  OBJECTIVE
  The aim of this study was to assess whether induction therapy with thalidomidecontaining regimens was associated with improved results compared to vincristine, doxorubicin, and dexamethasone, and whether cyclophosphamide, thalidomide, and dexamethasone were associated with better results than thalidomide and dexamethasone.
  
  
  METHODS
  The records of 152 patients who underwent autologous transplantation at this institution from August of 2004 to January of 2012 were reviewed, selecting those with at least partial response to a maximum of eight cycles of induction therapy and sufficient follow-up information for analysis.
  
  
  RESULTS
  This study included 89 patients; 44 were female, with a mean age of 55 years (there was a significant trend for increasing age over the years of the study).The median number of induction therapy cycles was four, again with a trend of increase over the years.At least a very good partial response to induction therapy was achieved more often in the cyclophosphamide, thalidomide, and dexamethasone group (61.1%) and in the thalidomide and dexamethasone group (59.2%) than in the vincristine, doxorubicin, and dexamethasone group (16.2%). The overall median progression-free survival was 34 months, with no statistically significant difference between the three groups. The overall median survival was not reached, and there was no significant difference between the three groups; the estimated five-year overall survival was 55%.
  
  
  CONCLUSIONS
  Although the quality of responses appeared to be better with thalidomidecontaining regimens, these improvements did not translate into improved long-term outcomes. Given its track record, cyclophosphamide, thalidomide, and dexamethasone is currently considered the preferred regimen for first-line induction therapy in the Brazilian public health system.
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.
authors.forename: Edvan de Queiroz
authors.initials: Ede Q
authors.lastname: Crusoe
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Higashi
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.
authors.forename: Maria Paula Nalesso Camargo
authors.initials: MP
authors.lastname: Padilha
authors.affiliation: Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.
authors.forename: Eliana Cristina Martins
authors.initials: EC
authors.lastname: Miranda
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.
authors.forename: Adriana Alvares
authors.initials: AA
authors.lastname: Quero
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.
authors.forename: Manuella de Souza Sampaio
authors.initials: Mde S
authors.lastname: Almeida
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.
authors.forename: Ana Lucia M
authors.initials: AL
authors.lastname: Peres
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Cury
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.
authors.forename: Carlos
authors.initials: C
authors.lastname: Chiattone
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.
authors.forename: Jose Carlos
authors.initials: JC
authors.lastname: Barros
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.
authors.forename: Vania Tietsche de Moraes
authors.initials: VT
authors.lastname: Hungria
keywords: Cyclophosphamide; Induction chemotherapy; Multiple myeloma; Thalidomide; Transplantation, autologous