Long Term Survival Following High-dose Sequential Therapy with Autologous Hematopoietic Cell Rescue for Multiple Myeloma
High-dose therapy (HDT) with autologous hematopoietic cell rescue (AHCR) improves survival in patients with multiple myeloma, but is not curative due to a continuous risk of relapse. One approach to try to reduce relapse is to optimize the pretransplant therapy and preparative regimen. We investigated the outcome of sequential HDT with AHCR. Patients were initially treated with standard dose chemotherapy (primarily VAD) to maximum response. They then received cyclophosphamide 4 gm/m2 followed by G-CSF and peripheral blood hematopoietic cell collection by apheresis upon count recovery. They were then treated with etoposide 2 gm/m2 followed by G-CSF and apheresis upon count recovery. The transplant preparative regimen consisted of carmustine 500 mg/m2 on day -4 and melphalan 200 mg/m2 on day -2 followed by AHCR on day 0. Seventy-seven patients were enrolled between 1997 and 2001. Patients were eligible for enrollment if they had a confirmed diagnosis of multiple myeloma at the transplant center, had received multi-agent based chemotherapy for cytoreduction, and had no serious comorbidities. The patient population included 56% men with a median age at transplant of 54 years (range 39-68 years). Thirty-eight patients had IgG myeloma, 14 patients had IgA myeloma, 8 patients had light chain only disease, 4 patients had nonsecretory disease and subtype is unknown in six patients. The median progression-free survival was 3.9 years [CI 2.7-6.0 years] with a median overall survival of 9.5 years (CI 4.7-11 years). The median follow up of the 36 surviving patients is 8.43 years with a range of 4.71 to 11.09 years. One patient was lost to follow up. The Kaplan-Meir estimated progression-free survival at 10 years is 35% with overall survival of 45%. One patient developed secondary acute myeloid leukemia and one patient developed secondary myelodysplastic syndrome. High dose sequential therapy results in long term survival in a significant proportion of patients with multiple myeloma.
Doan, PL; Chute, JP; Gasparetto, C; Horwitz, M; Rizzieri, D; Smith, C; Sullivan, K; Edwards, J; Jacobson, R; Corbett, K; Chao, N; Long, G
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American Society of Blood and Marrow Transplantation