title: Autologous Stem Cell Transplantation Is an Effective Salvage Therapy for Primary Refractory Multiple Myeloma.
abstract: High-dose therapy and autologous stem cell transplantation (ASCT) have proven efficacy in patients with multiple myeloma responding well to induction therapy. For those who fail to achieve a stable partial response (PR), the effect of ASCT is unclear. We report on 126 patients identified from a national database, who underwent ASCT having achieved <PR after induction with modern induction regimens. The overall response rate was 86% (24% complete response). Patients with progressive disease at the time of transplantation had poorer outcomes than those with minimally responsive or stable disease, but clinical benefit was seen in all groups. Day 100 and 1-year nonrelapse mortalities were 2% and 4%, respectively. The 5-year relapse rate and progression-free survival were 84% and 14% (median, 18 months), respectively. The 5-year overall survival was 42% (median, 51 months). Our findings support the use of ASCT in myeloma patients responding suboptimally to modern induction therapies. Patients should not be excluded on the basis of refractoriness to induction, as ASCT is effective in this group conventionally considered to have a poor outcome. Comprehensive multivariate analysis identified no disparate subgroups, meaning ASCT is a reasonable strategy for all fit primary refractory patients.
authors.affiliation: St James's Institute of Oncology, Leeds Teaching Hospitals Trust, Leeds, United Kingdom.
authors.forename: Christopher
authors.initials: C
authors.lastname: Parrish
authors.affiliation: Department of Haematology, Hammersmith Hospital, London, United Kingdom.
authors.forename: Amin
authors.initials: A
authors.lastname: Rahemtulla
authors.affiliation: Department of Haematology, The Christie & University of Manchester, Manchester, United Kingdom.
authors.forename: Jim
authors.initials: J
authors.lastname: Cavet
authors.affiliation: British Society of Blood and Marrow Transplantation Data Registry, Guy's Hospital, London, United Kingdom.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Pearce
authors.affiliation: British Society of Blood and Marrow Transplantation Data Registry, Guy's Hospital, London, United Kingdom.
authors.forename: Keiren
authors.initials: K
authors.lastname: Kirkland
authors.affiliation: British Society of Blood and Marrow Transplantation Data Registry, Guy's Hospital, London, United Kingdom.
authors.forename: Julia
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Cook
authors.affiliation: Department of Haematology, University Hospital of Wales, Cardiff, United Kingdom.
authors.forename: Keith
authors.initials: K
authors.lastname: Wilson
authors.affiliation: St James's Institute of Oncology, Leeds Teaching Hospitals Trust, Leeds, United Kingdom. Electronic address: Gordon.Cook@leedsth.nhs.uk.
authors.forename: Gordon
authors.initials: G
authors.lastname: Cook
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008558:Melphalan / Q000627:therapeutic use*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D009364:Neoplasm Recurrence, Local / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D012306:Risk; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D019653:Myeloablative Agonists; D008558:Melphalan
keywords: Autologous stem cell transplantation; Myeloma; Refractory disease