TY - JOUR
T1 - An elective single autograft with high-dose melphalan
T2 - Single-center study of 451 patients
AU - Sirohi, Bhawna
AU - Powles, R.
AU - Mehta, J.
AU - Rudin, C.
AU - Kulkarni, S.
AU - Horton, C.
AU - Saso, R.
AU - Singhal, S.
AU - Treleaven, J.
N1 - Funding Information:
This study was supported by the Bud Flanagan Leukaemia Fund, the David Adams Leukaemia Fund, the Johnsten Britten Myeloma Fund, the Cancer Research Campaign, and the Institute of Cancer Research. We acknowledge the help of Ms Gabriella Powles in assembling the patient case notes.
PY - 2005/7
Y1 - 2005/7
N2 - In all, 451 myeloma patients, 51% previously untreated, underwent elective single autotransplantation after 200 mg/m2 melphalan between 1985 and 2001 at the Royal Marsden Hospital. The therapy sequence was: Induction (vincristine, doxorubicin, methylprednisolone±cyclophosphamide), marrow or filgrastim-mobilized blood stem cell harvest, autograft, and interferon-α2b maintenance. A total of 27 (6%) died of transplant-related toxicity, all within 3 months. Complete or near-complete remission was seen in 59% with an overall response rate of 91%. Subsequent disease progression was seen in 285, and 17 died of unrelated causes. In all, 206 patients were alive at the last follow-up, 6 months to 17.7 years posttransplant (median 65 months); 122 without disease progression at 6 months to 17.7 years (median 58 months). The median overall (OS) and event-free (EFS) survivals were 5.9 and 2.4 years, with 10-year OS and EFS probabilities of 31.4 and 16.5%, respectively. In Cox analysis, it was seen that significantly longer OS occurred for patients who had β-2-microglobulin <3.5 mg/l (P<0.0001), age <60 years (P=0.001) and albumin ≥35 g/l (P=0.009). EFS was also longer if β-2-microglobulin was <3.5 mg/l (P=0.0056) and patients were <60 years of age (P=0.033). We conclude that with a single planned autograft, patients with myeloma have an excellent outcome.
AB - In all, 451 myeloma patients, 51% previously untreated, underwent elective single autotransplantation after 200 mg/m2 melphalan between 1985 and 2001 at the Royal Marsden Hospital. The therapy sequence was: Induction (vincristine, doxorubicin, methylprednisolone±cyclophosphamide), marrow or filgrastim-mobilized blood stem cell harvest, autograft, and interferon-α2b maintenance. A total of 27 (6%) died of transplant-related toxicity, all within 3 months. Complete or near-complete remission was seen in 59% with an overall response rate of 91%. Subsequent disease progression was seen in 285, and 17 died of unrelated causes. In all, 206 patients were alive at the last follow-up, 6 months to 17.7 years posttransplant (median 65 months); 122 without disease progression at 6 months to 17.7 years (median 58 months). The median overall (OS) and event-free (EFS) survivals were 5.9 and 2.4 years, with 10-year OS and EFS probabilities of 31.4 and 16.5%, respectively. In Cox analysis, it was seen that significantly longer OS occurred for patients who had β-2-microglobulin <3.5 mg/l (P<0.0001), age <60 years (P=0.001) and albumin ≥35 g/l (P=0.009). EFS was also longer if β-2-microglobulin was <3.5 mg/l (P=0.0056) and patients were <60 years of age (P=0.033). We conclude that with a single planned autograft, patients with myeloma have an excellent outcome.
KW - Melphalan 200 mg/m
KW - Multiple myeloma
KW - Single autotransplantation
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U2 - 10.1038/sj.bmt.1705000
DO - 10.1038/sj.bmt.1705000
M3 - Article
C2 - 15895115
AN - SCOPUS:21744439141
VL - 36
SP - 19
EP - 24
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
SN - 0268-3369
IS - 1
ER -