An analysis of which subgroups of multiple myeloma patients, divided according to β2-microglobulin and plasma cell labeling index, benefit from high dose vs conventional chemotherapy

Mario Boccadoro, Corrado Tarella, Antonio Palumbo, Chiara Argentino, Sabrina Triolo, Alida Dominietto, Vincenzo Callea, Vito Michele Lauta, Stefano Molica, Pellegrino Musto, Filippo Marmont, A. Massimo Gianni, Alessandro Pileri

Research output: Contribution to journalArticle

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Abstract

Background and Objectives. The clinical advantage of high-dose therapy (HDT) over standard treatment for multiple myeloma (MM) patients has been recently assessed. Which patient subgroups benefit most from this approach is unclear. Design and Methods. To address this issue, the outcome of 54 patients under 55 years old treated with HDT was compared with that of 101 age-matched controls selected from 390 patients who received standard melphalan and prednisone (MP) chemotherapy in a national multi-center trial (M90 protocol). Results. The complete response (CR) rate was 50% in the HDT group compared to 5% in the MP group. Event-free survival (EFS) was three times longer for the HDT patients (median 34.5 vs 12.2 months, p <0.0001), though the controls enjoyed a prolonged survival after relapse, and hence there was no statistically significant difference in OS. Overall survival (OS) was analyzed in relation to two major prognostic factors: β2- microglobulin (β2-M) and bone marrow plasma cell labeling index (LI). HDT significantly improved OS in poor prognosis patients with a high LI (>1.2%), (median 49.5 vs 32.5 months, p <0.03), whereas it did not prolong OS in poor prognosis patients with high β2-M (> 3 mg/L). Interpretation and Conclusions. In conclusion, HDT has a major impact on CR and EFS, and is the treatment of choice for patients with a high LI. Alternative strategies should be adopted in poor prognosis patients with high β2-M.

Original languageEnglish
Pages (from-to)905-910
Number of pages6
JournalHaematologica
Volume84
Issue number10
Publication statusPublished - Oct 1999

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Plasma Cells
Multiple Myeloma
Drug Therapy
Melphalan
Prednisone
Disease-Free Survival
Therapeutics
Clinical Protocols
Group Psychotherapy

Keywords

  • β-microglobulin
  • Autologous transplantation
  • Labeling index
  • Multiple myeloma

ASJC Scopus subject areas

  • Hematology

Cite this

An analysis of which subgroups of multiple myeloma patients, divided according to β2-microglobulin and plasma cell labeling index, benefit from high dose vs conventional chemotherapy. / Boccadoro, Mario; Tarella, Corrado; Palumbo, Antonio; Argentino, Chiara; Triolo, Sabrina; Dominietto, Alida; Callea, Vincenzo; Lauta, Vito Michele; Molica, Stefano; Musto, Pellegrino; Marmont, Filippo; Gianni, A. Massimo; Pileri, Alessandro.

In: Haematologica, Vol. 84, No. 10, 10.1999, p. 905-910.

Research output: Contribution to journalArticle

Boccadoro, M, Tarella, C, Palumbo, A, Argentino, C, Triolo, S, Dominietto, A, Callea, V, Lauta, VM, Molica, S, Musto, P, Marmont, F, Gianni, AM & Pileri, A 1999, 'An analysis of which subgroups of multiple myeloma patients, divided according to β2-microglobulin and plasma cell labeling index, benefit from high dose vs conventional chemotherapy', Haematologica, vol. 84, no. 10, pp. 905-910.
Boccadoro, Mario ; Tarella, Corrado ; Palumbo, Antonio ; Argentino, Chiara ; Triolo, Sabrina ; Dominietto, Alida ; Callea, Vincenzo ; Lauta, Vito Michele ; Molica, Stefano ; Musto, Pellegrino ; Marmont, Filippo ; Gianni, A. Massimo ; Pileri, Alessandro. / An analysis of which subgroups of multiple myeloma patients, divided according to β2-microglobulin and plasma cell labeling index, benefit from high dose vs conventional chemotherapy. In: Haematologica. 1999 ; Vol. 84, No. 10. pp. 905-910.
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abstract = "Background and Objectives. The clinical advantage of high-dose therapy (HDT) over standard treatment for multiple myeloma (MM) patients has been recently assessed. Which patient subgroups benefit most from this approach is unclear. Design and Methods. To address this issue, the outcome of 54 patients under 55 years old treated with HDT was compared with that of 101 age-matched controls selected from 390 patients who received standard melphalan and prednisone (MP) chemotherapy in a national multi-center trial (M90 protocol). Results. The complete response (CR) rate was 50{\%} in the HDT group compared to 5{\%} in the MP group. Event-free survival (EFS) was three times longer for the HDT patients (median 34.5 vs 12.2 months, p <0.0001), though the controls enjoyed a prolonged survival after relapse, and hence there was no statistically significant difference in OS. Overall survival (OS) was analyzed in relation to two major prognostic factors: β2- microglobulin (β2-M) and bone marrow plasma cell labeling index (LI). HDT significantly improved OS in poor prognosis patients with a high LI (>1.2{\%}), (median 49.5 vs 32.5 months, p <0.03), whereas it did not prolong OS in poor prognosis patients with high β2-M (> 3 mg/L). Interpretation and Conclusions. In conclusion, HDT has a major impact on CR and EFS, and is the treatment of choice for patients with a high LI. Alternative strategies should be adopted in poor prognosis patients with high β2-M.",
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AU - Boccadoro, Mario

AU - Tarella, Corrado

AU - Palumbo, Antonio

AU - Argentino, Chiara

AU - Triolo, Sabrina

AU - Dominietto, Alida

AU - Callea, Vincenzo

AU - Lauta, Vito Michele

AU - Molica, Stefano

AU - Musto, Pellegrino

AU - Marmont, Filippo

AU - Gianni, A. Massimo

AU - Pileri, Alessandro

PY - 1999/10

Y1 - 1999/10

N2 - Background and Objectives. The clinical advantage of high-dose therapy (HDT) over standard treatment for multiple myeloma (MM) patients has been recently assessed. Which patient subgroups benefit most from this approach is unclear. Design and Methods. To address this issue, the outcome of 54 patients under 55 years old treated with HDT was compared with that of 101 age-matched controls selected from 390 patients who received standard melphalan and prednisone (MP) chemotherapy in a national multi-center trial (M90 protocol). Results. The complete response (CR) rate was 50% in the HDT group compared to 5% in the MP group. Event-free survival (EFS) was three times longer for the HDT patients (median 34.5 vs 12.2 months, p <0.0001), though the controls enjoyed a prolonged survival after relapse, and hence there was no statistically significant difference in OS. Overall survival (OS) was analyzed in relation to two major prognostic factors: β2- microglobulin (β2-M) and bone marrow plasma cell labeling index (LI). HDT significantly improved OS in poor prognosis patients with a high LI (>1.2%), (median 49.5 vs 32.5 months, p <0.03), whereas it did not prolong OS in poor prognosis patients with high β2-M (> 3 mg/L). Interpretation and Conclusions. In conclusion, HDT has a major impact on CR and EFS, and is the treatment of choice for patients with a high LI. Alternative strategies should be adopted in poor prognosis patients with high β2-M.

AB - Background and Objectives. The clinical advantage of high-dose therapy (HDT) over standard treatment for multiple myeloma (MM) patients has been recently assessed. Which patient subgroups benefit most from this approach is unclear. Design and Methods. To address this issue, the outcome of 54 patients under 55 years old treated with HDT was compared with that of 101 age-matched controls selected from 390 patients who received standard melphalan and prednisone (MP) chemotherapy in a national multi-center trial (M90 protocol). Results. The complete response (CR) rate was 50% in the HDT group compared to 5% in the MP group. Event-free survival (EFS) was three times longer for the HDT patients (median 34.5 vs 12.2 months, p <0.0001), though the controls enjoyed a prolonged survival after relapse, and hence there was no statistically significant difference in OS. Overall survival (OS) was analyzed in relation to two major prognostic factors: β2- microglobulin (β2-M) and bone marrow plasma cell labeling index (LI). HDT significantly improved OS in poor prognosis patients with a high LI (>1.2%), (median 49.5 vs 32.5 months, p <0.03), whereas it did not prolong OS in poor prognosis patients with high β2-M (> 3 mg/L). Interpretation and Conclusions. In conclusion, HDT has a major impact on CR and EFS, and is the treatment of choice for patients with a high LI. Alternative strategies should be adopted in poor prognosis patients with high β2-M.

KW - β-microglobulin

KW - Autologous transplantation

KW - Labeling index

KW - Multiple myeloma

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