Limited feasibility of double transplant in multiple myeloma

Results of a multicenter study on 153 patients aged

Alessandro Corso, Silvia Mangiacavalli, Luciana Barbarano, Emilio Paolo Alessandrino, Roberto Cairoli, Enrica Morra, Mario Laziarino

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

BACKGROUND. Although high-dose therapy is considered the standard therapy for younger patients with multiple myeloma (MM), the advantages of performing a second transplant remain debated. The current study was conducted to evaluate the efficacy and the feasibility of a front-line double transplant program in young MM patients. METHODS. A total of 153 MM patients aged ≤65 years, the majority of whom had stage III disease (65%), were enrolled in a multicenter, nonrandomized, high-dose program including 2 transplants. RESULTS. The percentage of good quality responses (complete and very good partial responses) increased from an initial 33% after induction to 91% (complete response rate of 29%) after 2 transplants. However, this increase in response did not produce an advantage in either event-free survival or overall survival, even when the analysis was performed grouping patients by response. The protocol was well tolerated and no difference in transplant-related mortality was observed between the first and second transplants. A first transplant was performed in 122 of 153 patients (80%), and 65 (42% of the enrolled patients) completed the double transplant program. Reasons for not undergoing the second autologous transplant were death (n = 2 patients), insufficient peripheral blood stem cells (n = 8 patients), severe transplant-related toxicity (n = 10 patients), allotransplants (n = 9 patients), early progression after first transplant (n = 6 patients), lost to follow-up (n = 3 patients), and patient refusal (n = 19 patients). CONCLUSIONS. Considering the limited advantage of double transplants, the complexity of the program, the high percentage of dropouts, and the additional costs of a second transplant, the current study favors single transplant programs for the treatment of younger MM patients.

Original languageEnglish
Pages (from-to)2273-2278
Number of pages6
JournalCancer
Volume109
Issue number11
DOIs
Publication statusPublished - Jun 1 2007

Fingerprint

Multiple Myeloma
Multicenter Studies
Transplants
Lost to Follow-Up
Autografts
Disease-Free Survival
Therapeutics

Keywords

  • High-dose therapy
  • Multiple myeloma
  • Peripheral blood stem cells
  • Tandem transplant

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Limited feasibility of double transplant in multiple myeloma : Results of a multicenter study on 153 patients aged. / Corso, Alessandro; Mangiacavalli, Silvia; Barbarano, Luciana; Alessandrino, Emilio Paolo; Cairoli, Roberto; Morra, Enrica; Laziarino, Mario.

In: Cancer, Vol. 109, No. 11, 01.06.2007, p. 2273-2278.

Research output: Contribution to journalArticle

Corso, Alessandro ; Mangiacavalli, Silvia ; Barbarano, Luciana ; Alessandrino, Emilio Paolo ; Cairoli, Roberto ; Morra, Enrica ; Laziarino, Mario. / Limited feasibility of double transplant in multiple myeloma : Results of a multicenter study on 153 patients aged. In: Cancer. 2007 ; Vol. 109, No. 11. pp. 2273-2278.
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abstract = "BACKGROUND. Although high-dose therapy is considered the standard therapy for younger patients with multiple myeloma (MM), the advantages of performing a second transplant remain debated. The current study was conducted to evaluate the efficacy and the feasibility of a front-line double transplant program in young MM patients. METHODS. A total of 153 MM patients aged ≤65 years, the majority of whom had stage III disease (65{\%}), were enrolled in a multicenter, nonrandomized, high-dose program including 2 transplants. RESULTS. The percentage of good quality responses (complete and very good partial responses) increased from an initial 33{\%} after induction to 91{\%} (complete response rate of 29{\%}) after 2 transplants. However, this increase in response did not produce an advantage in either event-free survival or overall survival, even when the analysis was performed grouping patients by response. The protocol was well tolerated and no difference in transplant-related mortality was observed between the first and second transplants. A first transplant was performed in 122 of 153 patients (80{\%}), and 65 (42{\%} of the enrolled patients) completed the double transplant program. Reasons for not undergoing the second autologous transplant were death (n = 2 patients), insufficient peripheral blood stem cells (n = 8 patients), severe transplant-related toxicity (n = 10 patients), allotransplants (n = 9 patients), early progression after first transplant (n = 6 patients), lost to follow-up (n = 3 patients), and patient refusal (n = 19 patients). CONCLUSIONS. Considering the limited advantage of double transplants, the complexity of the program, the high percentage of dropouts, and the additional costs of a second transplant, the current study favors single transplant programs for the treatment of younger MM patients.",
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N2 - BACKGROUND. Although high-dose therapy is considered the standard therapy for younger patients with multiple myeloma (MM), the advantages of performing a second transplant remain debated. The current study was conducted to evaluate the efficacy and the feasibility of a front-line double transplant program in young MM patients. METHODS. A total of 153 MM patients aged ≤65 years, the majority of whom had stage III disease (65%), were enrolled in a multicenter, nonrandomized, high-dose program including 2 transplants. RESULTS. The percentage of good quality responses (complete and very good partial responses) increased from an initial 33% after induction to 91% (complete response rate of 29%) after 2 transplants. However, this increase in response did not produce an advantage in either event-free survival or overall survival, even when the analysis was performed grouping patients by response. The protocol was well tolerated and no difference in transplant-related mortality was observed between the first and second transplants. A first transplant was performed in 122 of 153 patients (80%), and 65 (42% of the enrolled patients) completed the double transplant program. Reasons for not undergoing the second autologous transplant were death (n = 2 patients), insufficient peripheral blood stem cells (n = 8 patients), severe transplant-related toxicity (n = 10 patients), allotransplants (n = 9 patients), early progression after first transplant (n = 6 patients), lost to follow-up (n = 3 patients), and patient refusal (n = 19 patients). CONCLUSIONS. Considering the limited advantage of double transplants, the complexity of the program, the high percentage of dropouts, and the additional costs of a second transplant, the current study favors single transplant programs for the treatment of younger MM patients.

AB - BACKGROUND. Although high-dose therapy is considered the standard therapy for younger patients with multiple myeloma (MM), the advantages of performing a second transplant remain debated. The current study was conducted to evaluate the efficacy and the feasibility of a front-line double transplant program in young MM patients. METHODS. A total of 153 MM patients aged ≤65 years, the majority of whom had stage III disease (65%), were enrolled in a multicenter, nonrandomized, high-dose program including 2 transplants. RESULTS. The percentage of good quality responses (complete and very good partial responses) increased from an initial 33% after induction to 91% (complete response rate of 29%) after 2 transplants. However, this increase in response did not produce an advantage in either event-free survival or overall survival, even when the analysis was performed grouping patients by response. The protocol was well tolerated and no difference in transplant-related mortality was observed between the first and second transplants. A first transplant was performed in 122 of 153 patients (80%), and 65 (42% of the enrolled patients) completed the double transplant program. Reasons for not undergoing the second autologous transplant were death (n = 2 patients), insufficient peripheral blood stem cells (n = 8 patients), severe transplant-related toxicity (n = 10 patients), allotransplants (n = 9 patients), early progression after first transplant (n = 6 patients), lost to follow-up (n = 3 patients), and patient refusal (n = 19 patients). CONCLUSIONS. Considering the limited advantage of double transplants, the complexity of the program, the high percentage of dropouts, and the additional costs of a second transplant, the current study favors single transplant programs for the treatment of younger MM patients.

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