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Autologous transplantation in multiple myeloma: a GITMO retrospective analysis on 290 patients. Gruppo Italiano Trapianti di Midollo Osseo.
Haematologica. 1999 Sep; 84(9):844-52.H

Abstract

BACKGROUND AND OBJECTIVE

Autologous transplantation is a better treatment for multiple myeloma (MM) than chemotherapy, but uncertainty remains about patient selection, optimal timing of autograft, conditioning regimen, need for a second autograft, and role of maintenance. To provide partial answers to these questions we assessed the results of autologous transplantation in a large cohort of patients whose data were reported to the GITMO registry.

DESIGN AND METHODS

We retrospectively analyzed data from 290 patients with MM (M = 150; F = 140; median age 52 years, range 19-70; stage I = 34, stage II = 75, stage III = 167) reported to the GITMO. At the time of autograft, 20% were in CR, 66% in PR, while the remaining had non-responsive or progressive disease. Median time between diagnosis and transplant was 16 months (1-90). Seventy-two patients (26%) had been planned to receive a double autograft, but this was actually done in only 35 (12%). The conditioning was chemotherapy in 90%. Peripheral blood was the only source of stem cells in 94%, and purging was applied in 10% of cases. For statistical analysis of data, differences between patient subsets were analyzed using the chi-square test, while the Kaplan-Meier method was used to estimate event-free survival (EFS) and survival (OS) probabilities. The Cox model was used for multivariate analysis.

RESULTS

Following the autograft, 116 patients (40%) were in CR, 144 (50%) in PR, 24 (8%) did not respond or progressed and 6 (2%) died before response evaluation. Transplant-related mortality occurred in 3%. At a median follow-up of 23 months, 223 (77%) patients are alive, 71 (24%) of them in CR, and 67 (23%) patients have died at a median time of 20 months (0-70). OS and EFS at 6 years are 47% and 28%, respectively, but the EFS curve shows no plateau. In multivariate analysis, age, beta2-microglobulin level and status at transplant emerged as significant prognostic factors for both OS and EFS, while time from diagnosis to transplant showed borderline significance.

INTERPRETATION AND CONCLUSIONS

Based on the prognostic factors identified in multivariate analysis, we were able to assess the weight of a single prognostic factor or their combinations on transplant outcome. We also calculated the probability of OS and EFS by the number of factors at the time of autograft. Autologous transplantation is a safe and effective procedure, not only in sensitive patients, but also in resistant cases, provided they are <55 years of age and have low beta2-microglobulin. It should be applied early after the diagnosis of multiple myeloma, following the delivery of brief primary chemotherapy.

Authors+Show Affiliations

Divisione di Ematologia e Centro Trapianti di Midollo Osseo, Azienda Ospedaliera V.Cervello, Via Trabucco 180, 90146 Palermo, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10477460

Citation

Majolino, I, et al. "Autologous Transplantation in Multiple Myeloma: a GITMO Retrospective Analysis On 290 Patients. Gruppo Italiano Trapianti Di Midollo Osseo." Haematologica, vol. 84, no. 9, 1999, pp. 844-52.
Majolino I, Vignetti M, Meloni G, et al. Autologous transplantation in multiple myeloma: a GITMO retrospective analysis on 290 patients. Gruppo Italiano Trapianti di Midollo Osseo. Haematologica. 1999;84(9):844-52.
Majolino, I., Vignetti, M., Meloni, G., Vegna, M. L., Scimè, R., Tringali, S., Amaddii, G., Coser, P., Tribalto, M., Raimondi, R., Bergonzi, C., Sajeva, M. R., Sica, S., Ferrando, F., Messina, G., & Mandelli, F. (1999). Autologous transplantation in multiple myeloma: a GITMO retrospective analysis on 290 patients. Gruppo Italiano Trapianti di Midollo Osseo. Haematologica, 84(9), 844-52.
Majolino I, et al. Autologous Transplantation in Multiple Myeloma: a GITMO Retrospective Analysis On 290 Patients. Gruppo Italiano Trapianti Di Midollo Osseo. Haematologica. 1999;84(9):844-52. PubMed PMID: 10477460.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Autologous transplantation in multiple myeloma: a GITMO retrospective analysis on 290 patients. Gruppo Italiano Trapianti di Midollo Osseo. AU - Majolino,I, AU - Vignetti,M, AU - Meloni,G, AU - Vegna,M L, AU - Scimè,R, AU - Tringali,S, AU - Amaddii,G, AU - Coser,P, AU - Tribalto,M, AU - Raimondi,R, AU - Bergonzi,C, AU - Sajeva,M R, AU - Sica,S, AU - Ferrando,F, AU - Messina,G, AU - Mandelli,F, PY - 1999/9/8/pubmed PY - 1999/9/8/medline PY - 1999/9/8/entrez SP - 844 EP - 52 JF - Haematologica JO - Haematologica VL - 84 IS - 9 N2 - BACKGROUND AND OBJECTIVE: Autologous transplantation is a better treatment for multiple myeloma (MM) than chemotherapy, but uncertainty remains about patient selection, optimal timing of autograft, conditioning regimen, need for a second autograft, and role of maintenance. To provide partial answers to these questions we assessed the results of autologous transplantation in a large cohort of patients whose data were reported to the GITMO registry. DESIGN AND METHODS: We retrospectively analyzed data from 290 patients with MM (M = 150; F = 140; median age 52 years, range 19-70; stage I = 34, stage II = 75, stage III = 167) reported to the GITMO. At the time of autograft, 20% were in CR, 66% in PR, while the remaining had non-responsive or progressive disease. Median time between diagnosis and transplant was 16 months (1-90). Seventy-two patients (26%) had been planned to receive a double autograft, but this was actually done in only 35 (12%). The conditioning was chemotherapy in 90%. Peripheral blood was the only source of stem cells in 94%, and purging was applied in 10% of cases. For statistical analysis of data, differences between patient subsets were analyzed using the chi-square test, while the Kaplan-Meier method was used to estimate event-free survival (EFS) and survival (OS) probabilities. The Cox model was used for multivariate analysis. RESULTS: Following the autograft, 116 patients (40%) were in CR, 144 (50%) in PR, 24 (8%) did not respond or progressed and 6 (2%) died before response evaluation. Transplant-related mortality occurred in 3%. At a median follow-up of 23 months, 223 (77%) patients are alive, 71 (24%) of them in CR, and 67 (23%) patients have died at a median time of 20 months (0-70). OS and EFS at 6 years are 47% and 28%, respectively, but the EFS curve shows no plateau. In multivariate analysis, age, beta2-microglobulin level and status at transplant emerged as significant prognostic factors for both OS and EFS, while time from diagnosis to transplant showed borderline significance. INTERPRETATION AND CONCLUSIONS: Based on the prognostic factors identified in multivariate analysis, we were able to assess the weight of a single prognostic factor or their combinations on transplant outcome. We also calculated the probability of OS and EFS by the number of factors at the time of autograft. Autologous transplantation is a safe and effective procedure, not only in sensitive patients, but also in resistant cases, provided they are <55 years of age and have low beta2-microglobulin. It should be applied early after the diagnosis of multiple myeloma, following the delivery of brief primary chemotherapy. SN - 0390-6078 UR - https://www.unboundmedicine.com/medline/citation/10477460/Autologous_transplantation_in_multiple_myeloma:_a_GITMO_retrospective_analysis_on_290_patients__Gruppo_Italiano_Trapianti_di_Midollo_Osseo_ L2 - http://www.diseaseinfosearch.org/result/4962 DB - PRIME DP - Unbound Medicine ER -