BACKGROUND: Several studies of autologous stem cell transplantation in primary refractory myeloma have produced encouraging results. However, the outcome of primary refractory patients with stable disease has not been analyzed separately from the outcome of patients with progressive disease. DESIGN AND METHODS: In the Spanish Myeloma Group 2000 trial, 80 patients with primary refractory myeloma (49 with stable disease and 31 with progressive disease), i.e. who were refractory to initial chemotherapy, were scheduled for tandem transplants (double autologous transplant or a single autologous transplant followed by an allogeneic transplant). Patients with primary refractory disease included those who never achieved a minimal response (≥ 25% M-protein decrease) or better. Responses were assessed using the European Bone Marrow Transplant criteria. RESULTS: There were no significant differences in the rates of partial response or better between patients with stable or progressive disease. However, 38% of the patients with stable disease at the time of transplantation remained in a stable condition or achieved a minimal response after transplantation versus 7% in the group with progressive disease (P=0.0017) and the rate of early progression after transplantation was significantly higher among the group with progressive disease at the time of transplantation (22% versus 2%; P=0.0043). After a median follow-up of 6.6 years, the median survival after first transplant of the whole series was 2.3 years. Progression-free and overall survival from the first transplant were shorter in patients with progressive disease (0.6 versus 2.3 years, P=0.00004 and 1.1 versus 6 years, P=0.00002, respectively). CONCLUSIONS: Our results show that patients with progressive refractory myeloma do not benefit from autologous transplantation, while patients with stable disease have an outcome comparable to those with chemosensitive disease.
BACKGROUND: Several studies of autologous stem cell transplantation in primary refractory myeloma have produced encouraging results. However, the outcome of primary refractory patients with stable disease has not been analyzed separately from the outcome of patients with progressive disease. DESIGN AND METHODS: In the Spanish Myeloma Group 2000 trial, 80 patients with primary refractory myeloma (49 with stable disease and 31 with progressive disease), i.e. who were refractory to initial chemotherapy, were scheduled for tandem transplants (double autologous transplant or a single autologous transplant followed by an allogeneic transplant). Patients with primary refractory disease included those who never achieved a minimal response (≥ 25% M-protein decrease) or better. Responses were assessed using the European Bone Marrow Transplant criteria. RESULTS: There were no significant differences in the rates of partial response or better between patients with stable or progressive disease. However, 38% of the patients with stable disease at the time of transplantation remained in a stable condition or achieved a minimal response after transplantation versus 7% in the group with progressive disease (P=0.0017) and the rate of early progression after transplantation was significantly higher among the group with progressive disease at the time of transplantation (22% versus 2%; P=0.0043). After a median follow-up of 6.6 years, the median survival after first transplant of the whole series was 2.3 years. Progression-free and overall survival from the first transplant were shorter in patients with progressive disease (0.6 versus 2.3 years, P=0.00004 and 1.1 versus 6 years, P=0.00002, respectively). CONCLUSIONS: Our results show that patients with progressive refractory myeloma do not benefit from autologous transplantation, while patients with stable disease have an outcome comparable to those with chemosensitive disease.
Authors: S Kumar; M Q Lacy; A Dispenzieri; S V Rajkumar; R Fonseca; S Geyer; C Allmer; T E Witzig; J A Lust; P R Greipp; R A Kyle; M R Litzow; M A Gertz Journal: Bone Marrow Transplant Date: 2004-07 Impact factor: 5.483
Authors: R Alexanian; D Weber; S Giralt; M Dimopoulos; K Delasalle; T Smith; R Champlin Journal: Bone Marrow Transplant Date: 2001-05 Impact factor: 5.483
Authors: J Bladé; J F San Miguel; M Fontanillas; J Esteve; J Maldonado; A Alcalá; S Brunet; J García-Conde; J Besalduch; M J Moro; J Fernández-Calvo; E Conde; L Font; S Gardella; M Carnero; F Carbonell; J M Martí; J Hernández-Martín; F Ortega; C Besses; J M Ribera; J Trujillo; M L Escudero; C Rozman; J Estapé; E Montserrat Journal: Hematol J Date: 2001
Authors: J Anthony Child; Gareth J Morgan; Faith E Davies; Roger G Owen; Susan E Bell; Kim Hawkins; Julia Brown; Mark T Drayson; Peter J Selby Journal: N Engl J Med Date: 2003-05-08 Impact factor: 91.245
Authors: E Nadal; E Giné; J Bladé; J Esteve; L Rosiñol; F Fernández-Avilés; P Marin; C Martinez; M Rovira; A Urbano-Ispizua; E Carreras; E Montserrat Journal: Bone Marrow Transplant Date: 2004-01 Impact factor: 5.483
Authors: Sergio Giralt; Laurent Garderet; Brian Durie; Gordon Cook; Gosta Gahrton; Benedetto Bruno; Paremesweran Hari; Henk Lokhorst; Phillip McCarthy; Amrita Krishnan; Pieter Sonneveld; Harmut Goldschmidt; Sundar Jagannath; Bart Barlogie; Maria Mateos; Peter Gimsing; Orhan Sezer; Joseph Mikhael; Jin Lu; Meletios Dimopoulos; Amitabha Mazumder; Antonio Palumbo; Rafat Abonour; Kenneth Anderson; Michel Attal; Joan Blade; Jenny Bird; Michele Cavo; Raymond Comenzo; Javier de la Rubia; Hermann Einsele; Ramon Garcia-Sanz; Jens Hillengass; Sarah Holstein; Hans Erik Johnsen; Douglas Joshua; Guenther Koehne; Shaji Kumar; Robert Kyle; Xavier Leleu; Sagar Lonial; Heinz Ludwig; Hareth Nahi; Anil Nooka; Robert Orlowski; Vincent Rajkumar; Anthony Reiman; Paul Richardson; Eloisa Riva; Jesus San Miguel; Ingemar Turreson; Saad Usmani; David Vesole; William Bensinger; Muzaffer Qazilbash; Yvonne Efebera; Mohamed Mohty; Christina Gasparreto; James Gajewski; Charles F LeMaistre; Chris Bredeson; Phillipe Moreau; Marcelo Pasquini; Nicolaus Kroeger; Edward Stadtmauer Journal: Biol Blood Marrow Transplant Date: 2015-09-30 Impact factor: 5.742
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Authors: Wilson I Gonsalves; Francis K Buadi; Sikander Ailawadhi; P Leif Bergsagel; Asher A Chanan Khan; David Dingli; Angela Dispenzieri; Rafael Fonseca; Susan R Hayman; Prashant Kapoor; Taxiarchis V Kourelis; Martha Q Lacy; Jeremy T Larsen; Eli Muchtar; Craig B Reeder; Taimur Sher; A Keith Stewart; Rahma Warsame; Ronald S Go; Robert A Kyle; Nelson Leung; Yi Lin; John A Lust; Stephen J Russell; Stephen R Zeldenrust; Amie L Fonder; Yi L Hwa; Miriam A Hobbs; Angela A Mayo; William J Hogan; S Vincent Rajkumar; Shaji K Kumar; Morie A Gertz; Vivek Roy Journal: Bone Marrow Transplant Date: 2018-07-09 Impact factor: 5.483