TY - JOUR
T1 - Response to induction chemotherapy is not essential to obtain survival benefit from high-dose melphalan and autotransplantation in myeloma
AU - Singhal, S.
AU - Powles, R.
AU - Sirohi, B.
AU - Treleaven, J.
AU - Kulkarni, S.
AU - Mehta, J.
N1 - Funding Information:
This study was supported by the Bud Flanagan Leukaemia Fund, the David Adams Leukaemia Fund, the Cancer Research Campaign and the Institute of Cancer Research.
PY - 2002/11
Y1 - 2002/11
N2 - Two hundred and twenty-two myeloma patients autografted after 200 mg/m2 melphalan were studied to examine the relationship between response to induction chemotherapy and outcome. Induction comprised cyclophosphamide, vincristine, doxorubicin and methylprednisolone (C-VAMP) every 3 weeks for one cycle beyond maximum response. 81% responded to C-VAMP (chemosensitive) with 40 complete (CR) and 139 partial (PR) remissions, and 43 did not respond (NR; <50% reduction in paraprotein; primary refractory). Overall, 130 patients (59%) attained or remained in CR post-transplant; including 40% of NR, 53% of PR, and 97% of CR after C-VAMP (P < 0.0001). Amongst these 130 patients, the 5-year OS was independent of response to C-VAMP (NR 79%, PR 74%, CR 60%; P = 0.69). Similarly, among the 69 patients in PR post-transplant, the 5-year OS was independent of response to C-VAMP. In Cox analysis, lack of response to C-VAMP did not affect outcome significantly. These data show that lack of response to induction therapy does not automatically predict poor long-term outcome in myeloma, since a substantial proportion of these patients attain CR after autograft and enjoy extended survival. Myeloma patients should not be disqualified from an autograft based upon lack of response to induction chemotherapy.
AB - Two hundred and twenty-two myeloma patients autografted after 200 mg/m2 melphalan were studied to examine the relationship between response to induction chemotherapy and outcome. Induction comprised cyclophosphamide, vincristine, doxorubicin and methylprednisolone (C-VAMP) every 3 weeks for one cycle beyond maximum response. 81% responded to C-VAMP (chemosensitive) with 40 complete (CR) and 139 partial (PR) remissions, and 43 did not respond (NR; <50% reduction in paraprotein; primary refractory). Overall, 130 patients (59%) attained or remained in CR post-transplant; including 40% of NR, 53% of PR, and 97% of CR after C-VAMP (P < 0.0001). Amongst these 130 patients, the 5-year OS was independent of response to C-VAMP (NR 79%, PR 74%, CR 60%; P = 0.69). Similarly, among the 69 patients in PR post-transplant, the 5-year OS was independent of response to C-VAMP. In Cox analysis, lack of response to C-VAMP did not affect outcome significantly. These data show that lack of response to induction therapy does not automatically predict poor long-term outcome in myeloma, since a substantial proportion of these patients attain CR after autograft and enjoy extended survival. Myeloma patients should not be disqualified from an autograft based upon lack of response to induction chemotherapy.
KW - Autotransplantation
KW - Chemosensitivity
KW - High-dose melphalan
KW - Multiple myeloma
KW - Primary refractory disease
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U2 - 10.1038/sj.bmt.1703717
DO - 10.1038/sj.bmt.1703717
M3 - Article
C2 - 12420206
AN - SCOPUS:0036861312
SN - 0268-3369
VL - 30
SP - 673
EP - 679
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
IS - 10
ER -