title: Clinical features and survival of 338 multiple myeloma patients treated with hematopoietic stem cell transplantation or conventional chemotherapy.
abstract: Therapeutic approaches against multiple myeloma (MM) have largely changed during the past decade. Hematopoietic stem cell transplantation (HSCT) and licensing of immunomodulators and proteasome inhibitors have resulted in better response and increased overall survival rates compared to previous conventional therapies. To assess the impact that these new strategies have had on outcome of patients with symptomatic MM in Spain, we conducted an epidemiological retrospective analysis of 338 newly diagnosed patients with stage II-III MM who started first-line treatment over a 2-yr period (2003-2005) by collecting data from their medical records. Most patients had been diagnosed with secretory MM (94.4%), 41.7% stage II and 58.3% stage III. The presence of bone lesions (72.2%), as well as anemia (79.8%) and elevated beta2-microglobulin levels (62.3%), was a common finding; in contrast, hypercalcemia and elevated serum creatinine were less frequent (25% each). First-line treatment had consisted of either conventional chemotherapy (62%) or induction treatment plus autologous HSCT (38%), as per standard clinical practice. HSCT not only resulted in greater objective response rates (93% vs. 50%), but also contributed to a significant increase in 3-yr survival (85% vs. 49.7%; 95% CI, range 77-91 vs. 41-58; P < 0.001). Overall, 55% of patients presented treatment-related adverse events, mainly hematological. Toxicity rates were higher among patients treated with alkylating-based regimens and in those undergoing transplantation. In conclusion, data analysis shows an adequate balance between increased response rates and safety that supports the use of up-front high-dose HSCT therapy in younger patients. Most importantly, this study provides further confirmation that the introduction of HSCT has significantly prolonged survival of patients with MM.
authors.affiliation: Hospital Universitario Virgen de Arrixaca, Murcia, Spain.
authors.forename: Raúl
authors.initials: R
authors.lastname: Pérez
authors.affiliation: Hospital Universitario Ciudad de Jaén, Jaén, Spain.
authors.forename: Ma Sol
authors.initials: MS
authors.lastname: Durán
authors.affiliation: Hospital Arnau de Vilanova, Valencia, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Mayans
authors.affiliation: Hospital Parc Tauli, Sabadell, Spain.
authors.forename: Alfons
authors.initials: A
authors.lastname: Soler
authors.affiliation: Hospital General Universitario de Elda, Alicante, Spain.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Castillo
authors.affiliation: Hospital Virgen de las Nieves, Granada, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Jurado
authors.affiliation: Hematology, Hospital Dr. Peset, Valencia, Spain.
authors.forename: Paz
authors.initials: P
authors.lastname: Ribas
authors.affiliation: Hospital Txagorritxu, Vitoria, Spain.
authors.forename: Ma Carmen
authors.initials: MC
authors.lastname: Menchaca Echevarria
authors.affiliation: Servicio de Hematología Clínica, Hospital Universitario de Canarias, Tenerife, Spain.
authors.forename: Miguel T
authors.initials: MT
authors.lastname: Hernandez
authors.affiliation: Hospital Santa Maria del Rosell, Cartagena, Spain.
authors.forename: Ma Dolores
authors.initials: MD
authors.lastname: Lopez Garcia-Carreño
authors.affiliation: Hospital de Donostia, San Sebastián, Spain.
authors.forename: Asunción
authors.initials: A
authors.lastname: Echeveste Gutierrez
authors.affiliation: Hospital de Antequera, Málaga, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Bailen Garcia
authors.affiliation: Celgene SL, Madrid, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Lopez
authors.affiliation: Celgene SL, Madrid, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Baquero
authors.affiliation: H.U. Virgen de la Victoria, Málaga, Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Ramirez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D006934:Hypercalcemia / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D060828:Induction Chemotherapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016019:Survival Analysis; D014182:Transplantation, Autologous; D001613:beta 2-Microglobulin / Q000097:blood
chemical_list: D001613:beta 2-Microglobulin; D003404:Creatinine
keywords: conventional therapy; hematopoietic stem cell transplantation; multiple myeloma; newly diagnosed patients; survival rate