Naslov
Efficacy of double autologous stem cell transplantation in multiple myeloma - A prospective single center experience in 71 patients

Autori
Nemet, Damir ; Sertić, Dubravka ; Mrsić, Mirando ; Bojanić, Ines ; Batinić, Drago ; Duraković, Nadira ; Golubić Ćepulić, Branka ; Serventi Seiwerth, Ranka ; Radman, Ivo ; Aurer, Igor ; Zupančić Šalek, Silva ; Labar, Boris.

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Hematologica / - , 2007, 256-256

Skup
12th Congress of the European Hematology Association

Mjesto i datum
Beč, Austrija, 07.06.2007. - 10.06.2007

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
Autologous stem cell transplantation ; multiple myeloma
(utologous stem cell transplantation ; multiple myeloma)

Sažetak
Background: Clinical trials so far have shown that high-dose therapy and ASCT) improves response rates, disease-free survival (DSF), and overall survival (OS) in symptomatic patients with multiple myeloma (MM) younger than 65 years. Recent studies indicate survival benefit for MM patients treated with double ASCT as compared to single transplant. We conducted a prospective trial of two successive ASCT in patients with advanced stage MM. The aim of the study was to evaluate feasibility, efficacy, and toxicity of this treatment approach. Patients: From December 1994 to November 2005 71 consecutive, previously untreated patients with MM stage II or III were included in the program of double HSCT. Patients who were pre-treated with melphalan or were treated with more than two chemotherapy regimens before ASCT were not included in the analysis. Median age of patients was 53 years (range 30-65 years), M/F ratio 39/32. Methods: Patients received induction with 3 to 10 cycles of VAD, few of them also other salvage regimen due to refractoriness to VAD. After achieving PR they proceed to mobilization procedure with cyclophosphamide 4 g/m2 and G-CSF. 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. Results: Sixty three patients (89%) actually received double transplant. Eight patients (11%) received only one transplant due to progression of the disease (1 pt), no enough stem cells for second transplant (3 pts), low performance status (3 pts) or refusal of second transplant (1 pt). A complete response was achieved in 47 patients (66%). With the median follow up of 45 months (range 10 to 150 months) 36 (51%) patients were alive in CR or VGPR, 19 (26%) were alive with disease, and 14 (20%) patients died from relapse. Only two patients died from transplant related complication (3%). Survival was calculated from the time of diagnosis. Probability of EFS at 7 years after the diagnosis was 35%. Median progression-free survival was 60 months. Probability of OS at seven years was 56% and the median survival was not reached. Multivariate analysis of parameters prior to transplantation identified age, disease stage at dg II vs III, preASCT response status CR/PR vs other, hemoglobin < 80 g/L, beta2 M > 2, 5 mg/L, and albumin < normal value as factors associated with OS and EFS after transplantation. Conclusion: Double ASCT is feasible in majority of patients, achieve a favorable EFS and OS and is associated with low TRM rate. The toxicity is low even in older patient population, not higher than with single transplant. For all patients with stage II or III MM double AHSCT should be planned from the time of diagnosis.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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