Upfront autologous stem cell transplantation for newly diagnosed elderly multiple myeloma patients: a prospective multicenter study.
The feasibility and efficacy of high-dose melphalan followed by autologous hematopoietic stem cell transplantation in newly diagnosed elderly patients with multiple myeloma was analyzed prospectively. Fifty-six multiple myeloma patients, aged 65 years or over, from 6 French centers were studied. The induction therapy was bortezomib-based in combination with dexamethasone and either thalidomide, cyclophosphamide or lenalidomide, for 4-6 cycles. Peripheral blood stem cells were collected after high-dose cyclophosphamide plus G-CSF or G-CSF alone, with plerixafor if needed. The conditioning regimen consisted of melphalan at 140 mg/m2in 18 patients (36%) and 200 mg/m2in 32 (64%). Three months post autologous hematopoietic stem cell transplantation, a 2-month consolidation phase with either lenalidomide plus dexamethasone or bortezomib-based combination therapy was allowed, but maintenance treatment was not given. All but 6 patients underwent autologous hematopoietic stem cell transplantation and 3 had tandem transplantations. The treatment-related mortality was 0% at 100 days post transplantation. Sixty-eight percent received consolidation therapy following transplantation. The best response achieved was 40% complete response, 36% very good partial response, and 18% partial response. After a median follow up of 21 months (range 6-31), the estimated progression-free and overall survival rates at two years were 76% [95%CI: (61.6-94.1)] and 88% [95%CI: (76.7-100)], respectively. The higher dose of melphalan (200 mg/m2) afforded superior progression-free and overall survival rates. This prospective study provides evidence for the safety and efficacy of autologous hematopoietic stem cell transplantation as a first-line treatment approach in elderly multiple myeloma patients. (clinicaltrials.gov identifier: 01671826).
INSERM, UMR_S 938, Proliferation and Differentiation of Stem Cells, AP-HP, Hôpital Saint Antoine, Département d'Hématologie et de Thérapie Cellulaire, F-75012, Paris, Université Pierre et Marie Curie-Paris 6, Paris, France laurent.garderet@aphp.fr.
Laurent
L
Garderet
EBMT Registry Office, Paris, Paris, France.
Eric
E
Beohou
CHRU Dijon, Paris, France.
Denis
D
Caillot
Department of Hematology, Institut Paoli Calmettes, Marseille, Paris, France.
Anne Marie
AM
Stoppa
Department of hematology, University Hospital Hotel Dieu, Nantes, Paris, France.
Cyrille
C
Touzeau
CHRU Dijon, Paris, France.
Marie Lorraine
ML
Chretien
Department of Hematology, CHU Lyon Sud, Pierre Bénite, Paris, France.
Lionel
L
Karlin
Department of hematology, University Hospital Hotel Dieu, Nantes, Paris, France.
Philippe
P
Moreau
Department of Hematology, CHU Besançon, Paris, France.
Jean
J
Fontan
Department of Hematology, Institut Paoli Calmettes, Marseille, Paris, France.
Didier
D
Blaise
EBMT Registry Office, Paris, Paris, France.
Emmanuelle
E
Polge
Hôpital Saint Antoine, Département d'Hématologie et de Thérapie Cellulaire, F-75012, Paris, France.
Mor Seny
MS
Gueye
Hôpital Saint Antoine, Département d'Hématologie et de Thérapie Cellulaire, F-75012, Paris, France.
Souhila
S
Ikhlef
Hôpital Saint Antoine, Département d'Hématologie et de Thérapie Cellulaire, F-75012, Paris, France.
Zora
Z
Marjanovic
EBMT Registry Office, Paris, Paris, France.
Myriam
M
Labopin
INSERM, UMR_S 938, Proliferation and Differentiation of Stem Cells, AP-HP, Hôpital Saint Antoine, Département d'Hématologie et de Thérapie Cellulaire, F-75012, Paris, Université Pierre et Marie Curie-Paris 6, Paris, France.
Mohamad
M
Mohty
D000368:Aged; D000369:Aged, 80 and over; D064592:Autografts; D060830:Consolidation Chemotherapy; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D009101:Multiple Myeloma / Q000401:mortality / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods*; D011446:Prospective Studies; D012074:Remission Induction; D016019:Survival Analysis; D019172:Transplantation Conditioning
D008558:Melphalan