title: Long-term follow-up of patients with multiple myeloma treated with total body irradiation-Melphalan conditioning.
abstract: OBJECTIVE
  Since a study published in 2002 showed a survival advantage of melphalan-only conditioning for stem cell transplantation (HSCT) over melphalan-total body irradiation (mel-TBI) in patients with multiple myeloma (MM), most centers abandoned mel-TBI. Mel-TBI causes more early toxicity and is more complicated to administer, but we speculated it may result in longer term survival with radiation as an independent treatment modality. Therefore, we analyzed the long-term outcome of patients with MM who received mel-TBI as part of conditioning at our center.
  
  
  METHODS
  From 1995 to 2013, 50 patients with MM underwent autologous HSCT at Tulane University Medical Center using mel-TBI conditioning. We used Kaplan-Meier survival analysis and compared our patients with data available from the Louisiana Tumor Registry.
  
  
  RESULTS
  The mean survival of our patients was 70.98 months from time of transplant and 84.2 months from time of initial diagnosis. No differences were observed according to gender, ethnicity, or age at transplant. The expected median survival in a population-based registry (matched for age and year of treatment) was 27 months (P<.001).
  
  
  CONCLUSIONS
  Total body irradiation in conjunction with melphalan as conditioning is feasible and can lead to long-term survival. More research is necessary to determine which patients benefit most. Mel-TBI should also be explored in conjunction with immunotherapy.
authors.affiliation: Department of Medicine (Hematology/Oncology), Tulane University Medical Center, New Orleans, LA, USA.
authors.forename: Reinhold
authors.identifier: http://orcid.org/0000-0001-7679-5071
authors.initials: R
authors.lastname: Munker
authors.affiliation: Department of Medicine (Hematology/Oncology), Tulane University Medical Center, New Orleans, LA, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Baghian
authors.affiliation: Department of Medicine (Hematology/Oncology), Tulane University Medical Center, New Orleans, LA, USA.
authors.forename: Yordanka
authors.initials: Y
authors.lastname: Koleva
authors.affiliation: Louisiana Tumor Registry, LSU School of Public Health, New Orleans, LA, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Andrews
authors.affiliation: School of Public Health, Tulane University Medical Center, New Orleans, LA, USA.
authors.forename: Gunita S
authors.initials: GS
authors.lastname: Matharoo
authors.affiliation: Department of Radiation Oncology, Tulane University Medical Center, New Orleans, LA, USA.
authors.forename: Ato E
authors.initials: AE
authors.lastname: Wright
authors.affiliation: Department of Medicine (Hematology/Oncology), Tulane University Medical Center, New Orleans, LA, USA.
authors.forename: Nakhle S
authors.initials: NS
authors.lastname: Saba
authors.affiliation: Department of Medicine (Hematology/Oncology), Tulane University Medical Center, New Orleans, LA, USA.
authors.forename: Roy S
authors.initials: RS
authors.lastname: Weiner
authors.affiliation: Department of Medicine (Hematology/Oncology), Tulane University Medical Center, New Orleans, LA, USA.
authors.forename: Hana
authors.initials: H
authors.lastname: Safah
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008558:Melphalan / Q000008:administration & dosage*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D019233:Retreatment; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014916:Whole-Body Irradiation / Q000379:methods
chemical_list: D008558:Melphalan
keywords: Autologous stem cell transplantation; Conditioning; Multiple myeloma; Total body irradiation