High-dose therapy and autologous blood stem cell transplantation in multiple myeloma: Preliminary results of a randomized trial involving 167 patients

Abstract

Since 1986, we have treated young patients with aggressive multiple myeloma (MM) by high-dose chemotherapy (HDC) and total body irradiation (TBI) followed with autologous blood stem cell transplantation (ABSCT). To evaluate this strategy: 1) We conducted a phase II trial that included 63 patients. Within a median follow-up of five years after transplantation, overall survival was 60% and median event-free survival was four years, and 2) In the early 1990s, we initiated a prospective trial where, after collection of chemotherapy-mobilized ABSC, patients under 55 years of age with newly diagnosed MM were randomly assigned either to HDC and TBI supported with ABSCT (high-dose therapy [HDT] arm) or to a conventional vincristine, melphalan, cyclophosphamide and prednisone (VMCP) regimen (VMCP arm). In the latter, HDT with ABSCT was performed as a rescue therapy, in case of primary resistance to VMCP or at relapse in responders. As of June 1994, 167 patients have been enrolled since a median time of 26 months. Fourteen (8%) could not be randomized. Among the randomized patients (n = 153), 30 deaths were observed, 13 in the HDT group and 17 in the VMCP group (p = 0.28, two-sided log rank test). Overall survival rates at two years were estimated at 78% for all 167 patients, at 82% in the HDT group and at 67% in the VMCP group. ABSC, provided they are collected early in the disease course, allow a great majority of myeloma patients to receive HDT.(ABSTRACT TRUNCATED AT 250 WORDS)

Definition of organ involvement and treatment response in immunoglobulin light chain amyloidosis (AL): A consensus opinion from the 10th International Symposium on Amyloid and Amyloidosis

“…The hematologic response criteria for amyloidosis have been modeled after those used for multiple myeloma [91] (Table IV). However, the interpretation is more complex than in multiple myeloma.…”

Multiple myeloma: 2013 update on diagnosis, risk‐stratification, and management

“…ASCT improves median OS in multiple myeloma by approximately 12 months [85][86][87][88]. However, three randomized trials show that OS is similar whether ASCT is done early (immediately following four cycles of induction therapy) or delayed (at the time of relapse as salvage therapy) [89][90][91]. Further, in a Spanish randomized trial, patients responding to induction therapy failed to benefit from ASCT trial, suggesting that the greatest benefit from early ASCT may be mainly among the small proportion of patients with disease refractory to induction therapy [92].…”

Sequential analysis of bone marrow and peripheral blood after stem cell transplant for myeloma shows disparate tumor involvement

“…positive selection techniques such as CD34 affinity devices can further deplete the harvest of tumor cells by as much as TBI, should allow one to monitor the extent to which each compartment is contaminated both before and after transplan-4-logs. 28 However, relapse remains common even after PBSCT, 3,12 suggesting that incomplete eradication of the tation. Although CD34 selection of the autograft can enrich stem cells and likely deplete tumor, this approach has not tumor within the patient is the primary contributor to relapse.…”