engleski

TREATMENT OF MULTIPLE MYELOMA WITH DOUBLE AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION - A PROSPECTIVE SINGLE CENTER STUDY

Recent nonrandomised and randomised studies indicate survival benefit for multiple myeloma (MM) patients treated with double autologous haematopoietic stem cell transplantation (AHSCT) as compared to single AHSCT. We conducted a prospective trial of the treatment of MM with high-dose chemotherapy and two successive AHSCT. Patients who were pretreated with melphalan or were treated with more than two chemotherapy regimens before AHSCT were excluded from the analysis. From December 1994 to September 2004 58 consecutive, previously untreated patients with MM stage II or III were included in the program of double HSCT. Median age of patients was 50 years (range 30-65 years), male/female ratio 30/28. After diagnosis was established they received 3 to 8 cycles of VAD therapy, few of them also other salvage regimen or thalidomide due to refractoriness to VAD protocol. After achieving partial response (less than 30% of plasma cells in the bone marrow aspirate) they proceed to mobilisation procedure with cyclophosphamide 4 g/m2 and G-CSF. Fifty patients (86 %) actually received double transplant. Eight patients (14 %) received only single transplant for several reasons (progression of the disease, refused second transplant, toxicity, no enough stem cells for second transplant, low performance status). Conditioning regimen for majority of patients consisted of melphalan 200 mg/m2, 24 patients received melphalan 140 mg/m2 and fractionated TBI 800 cGy prior to second transplant. A complete or very good partial response was achieved in 51 patients (89%). With the median follow up of 37 months (range 10 to 136 months) 37 (64%) patients were alive in CR or VGPR, 11 (19%) were alive in relapse, and 8 (14%) patients died from relapse. Only one patient died from transplant related complication (2%). Survival was calculated from the time of diagnosis. Probability of EFS at 7 years after the diagnosis was 35%. Median relapse-free survival was 55 months. Probability of overall survival (OS) at seven years was 66% and the median survival was not reached. Although the follow-up is still relatively short we conclude that double SCT is feasible in majority of patients, achieve a favourable DFS and OS and is associated with low TRM rate. For all patients with MM in the stage II or III double AHSCT should be recommended and planned from the time of diagnosis.

multiple myeloma; double transplantation

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