Prognostic Factors in Autologous Stem Cell Transplantation for Multiple Myeloma: An EBMT Registry Study

Abstract

Autologous bone marrow- and blood progenitor cell transplantation was performed in 130 patients with multiple myeloma in 16 European centers between 1986 and 1993. At the time of follow-up, 77 patients were alive and 53 were dead. Complete remission after transplantation was obtained in 47% of all patients. The actuarial survival at 65 months was 28%. The median duration of relapse-free survival among patients who were in complete remission after transplantation was 29 months. The following factors were predictive for longer survival and freedom of progression in a univariate analysis: Male sex, age less than 45 years, a low serum-beta-2-microglobulin value at diagnosis, prior administration of only one treatment regimen, response on conventional chemotherapy immediately pretransplant and the use of a preparative regimen including melphalan. The last factor, in addition to stage I disease at diagnosis, male sex and responsive disease immediately pretransplant, were also demonstrated as independent predictive variables for longer survival in a multivariate analysis. Progression-free survival was significantly better for patients who were in complete remission after transplantation, as compared to those with persisting signs of disease. We conclude that high-dose chemo-radiotherapy with autologous stem cell transplantation can induce long-term responses, primarily in younger, male patients with chemotherapy-responsive early disease. High-dose melphalan, as single drug or in combination, appeared to be superior to other regimens. The chance of being persistently disease-free seemed to be greatest for patients being in complete remission already before the transplantation.

Relevance of age on survival of 341 patients with multiple myeloma treated with conventional chemotherapy: updated results of the MM87 prospective randomized protocol

“…Median survival was 44 months in our series and 28-41 months in autologous BMT series (Jagannath et al, 1993;Bjorkstrand et al, 1994;Besinger et al, 1996;Vesole et al, 1996). In the only published series in which patients aged less than 55 years were treated with allogeneic BMT (Gahrton et al, 1995), median survival was 17 months and 4-year survival was 34%.…”

“…The tables are compiled using median and 4-year survival, as the commonest data can be found in most BMT series (Fermand et al, 1993;Jagannath et al, 1993;Bjorkstrand et al, 1994;Cunningham et al, 1994;Harosseau et al, 1995;Attal et al, 1996;Bensiger et al, 1996;Marit et al, 1996;Vesole et al, 1996) and are useful for comparison with our series (Table 3). Additionally, for literature series, data on 4-year survival given by the authors (as a % of single series) have also been cumulated by calculating the actual percentage of patients of all series surviving 4 years.…”

“…autologous BMT series with lower median age (Jagannath et al, 1993;Bjorkstrand et al, 1994;Cunningham et al, 1994;Bensiger et al, 1996;Vesole et al, 1996). Median survival was 44 months in our series and 28-41 months in autologous BMT series (Jagannath et al, 1993;Bjorkstrand et al, 1994;Besinger et al, 1996;Vesole et al, 1996).…”

“…The relevance of age tends to be lower when this parameter is included as a continuous variable into multiple regression analysis (Grignani et al, 1995). The actual more relevant prognostic role for relatively young age in MM is that it is a prerequisite for administering allogeneic or autologous bone marrow transplantation (BMT) (Fermand et al, 1993;Jagannath et al, 1993;Bjorkstrand et al, 1994;Cunningham et al, 1994;Gharton et al, 1995;Harosseau et al, 1995Harosseau et al, , 1996Attal et al, 1996;Bensiger et al, 1996;Marit et al, 1996;Vesole et al, 1996).…”

Prognostic value of bone marrow angiogenesis in multiple myeloma: Use of light microscopy as well as computerized image analyzer in the assessment of microvessel density and total vascular area in multiple myeloma and its correlation with various clinical, histological, and laboratory parameters

“…As the serum b 2 M level in the serum depends on both myeloma cell volume and renal function, measurement of serum b 2 M levels may be considered an alternative to clinical staging to predict survival [29][30][31].…”