Long-term outcome results of the first tandem autotransplant trial for multiple myeloma

Bart Barlogie*, Guido J. Tricot, Frits Van Rhee, Edguardo Angtuaco, Ron Walker, Joshua Epstein, John D. Shaughnessy, Sundar Jagannath, Vanessa Bolejack, Jennifer Gurley, Antje Hoering, David Vesole, Raman Desikan, David Siegel, Jayesh Mehta, Seema Singhal, Nikhil C. Munshi, Madhav Dhodapkar, Bonnie Jenkins, Michel AttalJean Luc Harousseau, John Crowley

*Corresponding author for this work

Research output: Contribution to journalArticle

142 Scopus citations

Abstract

Total Therapy 1, the first tandem autotransplant trial for newly diagnosed patients with multiple myeloma, was designed to increase the frequency of complete response (CR) and thereby extend survival. With a median follow-up of 12 years, 62 of 231 initially enrolled patients are alive (17% at 15 years); 31 remain event free (7% at 15 years) including 16 of 94 (41%) that initially achieved CR. Currently alive patients less frequently had cytogenetic abnormalities (CAs) at baseline (P = 0.002), postenrolment (P < 0.001) and at relapse (P = 0.004); elevations of serum C-reactive protein (CRP) (P = 0.003) and lactate dehydrogenase (P = 0.029), anaemia (P = 0.029) and they more often completed two transplants within 12 months (P = 0.019). Postenrolment overall survival (OS) and event-free survival (EFS) were superior in the absence of CA of the hypodiploidy or deletion 13 variety (P < 0.001 and 0.037 respectively) and in the presence of low CRP at baseline (P = 0.001 and 0.017 respectively). Postrelapse survival was longer in the absence of CA at relapse (P < 0.001), IgA isotype (P = 0.002), International Staging System stage 3 (P = 0.014), and when patients had two protocol transplants prior to relapse (P = 0.038). Ten-year EFS and OS could be accomplished in 15% and 33% of patients, respectively, when all agents available in 1989, especially high-dose melphalan, were applied together upfront for the management of myeloma.

Original languageEnglish (US)
Pages (from-to)158-164
Number of pages7
JournalBritish Journal of Haematology
Volume135
Issue number2
DOIs
StatePublished - Oct 1 2006

Keywords

  • High-dose melphalan
  • Myeloma
  • Prognosis

ASJC Scopus subject areas

  • Hematology

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    Barlogie, B., Tricot, G. J., Van Rhee, F., Angtuaco, E., Walker, R., Epstein, J., Shaughnessy, J. D., Jagannath, S., Bolejack, V., Gurley, J., Hoering, A., Vesole, D., Desikan, R., Siegel, D., Mehta, J., Singhal, S., Munshi, N. C., Dhodapkar, M., Jenkins, B., ... Crowley, J. (2006). Long-term outcome results of the first tandem autotransplant trial for multiple myeloma. British Journal of Haematology, 135(2), 158-164. https://doi.org/10.1111/j.1365-2141.2006.06271.x