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Limited feasibility of double transplant in multiple myeloma
Results of a multicenter study on 153 patients aged <65 years
Article first published online: 17 APR 2007
Copyright © 2007 American Cancer Society
Volume 109, Issue 11, pages 2273–2278, 1 June 2007
How to Cite
Corso, A., Mangiacavalli, S., Barbarano, L., Alessandrino, E. P., Cairoli, R., Morra, E., Lazzarino, M. and on Behalf of the HOST Group (2007), Limited feasibility of double transplant in multiple myeloma. Cancer, 109: 2273–2278. doi: 10.1002/cncr.22660
- Issue published online: 18 MAY 2007
- Article first published online: 17 APR 2007
- Manuscript Accepted: 19 JAN 2007
- Manuscript Revised: 17 JAN 2007
- Manuscript Received: 28 NOV 2006
- tandem transplant;
- multiple myeloma;
- high-dose therapy;
- peripheral blood stem cells
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.
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.
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).
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. Cancer 2007. © 2007 American Cancer Society.