title: Impact of CR before and after allogeneic and autologous transplantation in multiple myeloma: results from the EBMT NMAM2000 prospective trial.
abstract: Previous studies have shown that obtaining complete hematologic remission (CR) in multiple myeloma is an important predictor of PFS and OS. This applies both to autologous and allogeneic transplantation. However, the importance of CR obtained before vs after second transplant or following allogeneic vs autologous transplantation is not clear. We investigated the role of CR analyzing data from the EBMT-NMAM2000 interventional prospective study comparing tandem autologous/reduced intensity conditioning allogeneic transplantation (auto/RICallo) to autologous transplantation-single or double (auto/auto). Allocation to treatment was performed according to availability of a matched sibling donor. Cox regression and multi-state models were applied. The long-term probability of survival in CR was superior in auto/RICallo, both comparing groups according to treatment allocated at start (28.8 vs 11.4% at 60 months, P=0.0004) and according to actual administration of second transplant (25.6 vs 9.6% at 60 months, P=0.008). CR achieved before the second transplant was predictive for PFS (hazard ratio (HR)=0.44, P= 0.003) and OS (HR 0.51, P=0.047) irrespective of the type of second transplant. CR achieved after auto/RICallo was more beneficial for PFS (HR=0.53, P=0.027) than CR after auto/auto (HR=0.81, P=0.390), indicating a better durability of CR obtained after an allotransplant procedure.
authors.affiliation: Centro Interdipartimentale di Biostatistica e Bioinformatica, Università di Roma 'Tor Vergata', Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Iacobelli
authors.affiliation: Department of Biostatistics and Bioinformatic, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: L C
authors.initials: LC
authors.lastname: de Wreede
authors.affiliation: Department of Medicine V, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Schönland
authors.affiliation: Hematology Center/Huddinge, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Björkstrand
authors.affiliation: Department of Medicine V, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Hegenbart
authors.affiliation: Department of Medicine, Karolinska Institute at Huddinge and Solna, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Gruber
authors.affiliation: Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
authors.forename: H
authors.initials: H
authors.lastname: Greinix
authors.affiliation: Helsinki University Central Hospital, Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland.
authors.forename: L
authors.initials: L
authors.lastname: Volin
authors.affiliation: Department of Oncology Hematology & Respiratory Diseases, AOU Policlinico Modena, University of Modena, Modena, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Narni
authors.affiliation: Department of Hematology and Stem Cell Transplant Unit, CSS Hospital IRCCS, S.G. Rotondo, Italy.
authors.forename: A M
authors.initials: AM
authors.lastname: Carella
authors.affiliation: Department of Hematology, Ankara University Faculty of Medicine, Ankara, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Beksac
authors.affiliation: Department of Haematology, University of Florence, Careggi Hospital, Florence, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bosi
authors.affiliation: Department of Haematology, Ospedale Ferrarotto, Catania, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Milone
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milano, Milano, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Corradini
authors.affiliation: Department of Medicine, Karolinska Institute at Huddinge and Solna, Stockholm, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Friberg
authors.affiliation: Department of Biostatistics and Bioinformatic, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: van Biezen
authors.affiliation: Department of Medicine V, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Goldschmidt
authors.affiliation: Department of Tumor Immunology, Nijmegen Institute of Life Sciences, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: de Witte
authors.affiliation: Department of Haematology, The Queens University, Belfast, UK.
authors.forename: C
authors.initials: C
authors.lastname: Morris
authors.affiliation: Division of Hematology and Medical Oncology, University Hospital Leipzig, Leipzig, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Niederwieser
authors.affiliation: Département d'hématologie et de thérapie cellulaire, Hopital St Antoine, Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Garderet
authors.affiliation: Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Kröger
authors.affiliation: Department of Medicine, Karolinska Institute at Huddinge and Solna, Stockholm, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Gahrton
mesh_terms: D064591:Allografts; D064592:Autografts; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality* / Q000628:therapy*; D011446:Prospective Studies; D012074:Remission Induction; D033581:Stem Cell Transplantation; D015996:Survival Rate