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Transplantation as salvage therapy for high-risk patients with myeloma in relapse.
Bone Marrow Transplant. 2002 Dec; 30(12):873-8.BM

Abstract

Patients with myeloma relapsing after tandem transplant have a poor survival and treatment options are limited. The role of additional salvage transplant procedures for these patients is unknown. To evaluate the benefit and identify prognostic factors, the outcome of 76 consecutive patients with recurrent myeloma after tandem transplant receiving salvage transplants (ST) was analyzed. Prior to ST, 23 patients (30%) had shown chemosensitive response to preceding salvage chemotherapy: two complete remissions (CR); eight near CRs (nCR: only immunofixation positive); 13 partial remissions (PR >or=75% reduction in M protein). Fifty received an autologous transplant, 22 a sibling-matched allogeneic transplant, and four a matched-unrelated allogeneic transplant. Overall response after ST was 59%: eight CRs (11%); 14 nCRs (18%); 23 PRs (30%). Overall survival (OS) at 2 years was 19%; 2 year event-free survival rate (EFS) 7%. On univariate analysis for survival, only pre-transplant chemosensitive relapse (P < 0.05), serum albumin >3 g/dl (P = 0.001), normal LDH (P = 0.04), and long interval between the second transplant and relapse/progression were significant beneficial factors. In a Cox proportional hazard model, chemosensitive relapse, and albumin >3 g/dl were significant for better OS: hazard ratio (HR) 1.4, 1.7, respectively, while normal LDH, and absence of CA13 were significant for better EFS: HR 1.8, 1.7, respectively. Patients with albumin >3 g/dl who had chemosensitive disease before ST (n = 16) had a median survival of 16 months, compared to 7 months (n = 34) and 2 months (n = 26) for patients with only one (n = 34) or no favorable prognostic factors (n = 28), respectively (P < 0.001). Their survival at 2 years post-ST was 43%, 17% and 11%, respectively. Our study suggests further transplantation should only be considered in the setting of a clinical trial in patients with favorable prognostic factors.

Authors+Show Affiliations

The Myeloma Institute for Research and Therapy, The University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.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 available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12476279

Citation

Lee, C-K, et al. "Transplantation as Salvage Therapy for High-risk Patients With Myeloma in Relapse." Bone Marrow Transplantation, vol. 30, no. 12, 2002, pp. 873-8.
Lee CK, Barlogie B, Zangari M, et al. Transplantation as salvage therapy for high-risk patients with myeloma in relapse. Bone Marrow Transplant. 2002;30(12):873-8.
Lee, C. K., Barlogie, B., Zangari, M., Fassas, A., Anaissie, E., Morris, C., Van Rhee, F., Cottler-Fox, M., Thertulien, R., Muwalla, F., Mazher, S., Badros, A., & Tricot, G. (2002). Transplantation as salvage therapy for high-risk patients with myeloma in relapse. Bone Marrow Transplantation, 30(12), 873-8.
Lee CK, et al. Transplantation as Salvage Therapy for High-risk Patients With Myeloma in Relapse. Bone Marrow Transplant. 2002;30(12):873-8. PubMed PMID: 12476279.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transplantation as salvage therapy for high-risk patients with myeloma in relapse. AU - Lee,C-K, AU - Barlogie,B, AU - Zangari,M, AU - Fassas,A, AU - Anaissie,E, AU - Morris,C, AU - Van Rhee,F, AU - Cottler-Fox,M, AU - Thertulien,R, AU - Muwalla,F, AU - Mazher,S, AU - Badros,A, AU - Tricot,G, PY - 2002/03/15/received PY - 2002/06/14/accepted PY - 2002/12/12/pubmed PY - 2003/8/2/medline PY - 2002/12/12/entrez SP - 873 EP - 8 JF - Bone marrow transplantation JO - Bone Marrow Transplant VL - 30 IS - 12 N2 - Patients with myeloma relapsing after tandem transplant have a poor survival and treatment options are limited. The role of additional salvage transplant procedures for these patients is unknown. To evaluate the benefit and identify prognostic factors, the outcome of 76 consecutive patients with recurrent myeloma after tandem transplant receiving salvage transplants (ST) was analyzed. Prior to ST, 23 patients (30%) had shown chemosensitive response to preceding salvage chemotherapy: two complete remissions (CR); eight near CRs (nCR: only immunofixation positive); 13 partial remissions (PR >or=75% reduction in M protein). Fifty received an autologous transplant, 22 a sibling-matched allogeneic transplant, and four a matched-unrelated allogeneic transplant. Overall response after ST was 59%: eight CRs (11%); 14 nCRs (18%); 23 PRs (30%). Overall survival (OS) at 2 years was 19%; 2 year event-free survival rate (EFS) 7%. On univariate analysis for survival, only pre-transplant chemosensitive relapse (P < 0.05), serum albumin >3 g/dl (P = 0.001), normal LDH (P = 0.04), and long interval between the second transplant and relapse/progression were significant beneficial factors. In a Cox proportional hazard model, chemosensitive relapse, and albumin >3 g/dl were significant for better OS: hazard ratio (HR) 1.4, 1.7, respectively, while normal LDH, and absence of CA13 were significant for better EFS: HR 1.8, 1.7, respectively. Patients with albumin >3 g/dl who had chemosensitive disease before ST (n = 16) had a median survival of 16 months, compared to 7 months (n = 34) and 2 months (n = 26) for patients with only one (n = 34) or no favorable prognostic factors (n = 28), respectively (P < 0.001). Their survival at 2 years post-ST was 43%, 17% and 11%, respectively. Our study suggests further transplantation should only be considered in the setting of a clinical trial in patients with favorable prognostic factors. SN - 0268-3369 UR - https://www.unboundmedicine.com/medline/citation/12476279/Transplantation_as_salvage_therapy_for_high_risk_patients_with_myeloma_in_relapse_ L2 - https://doi.org/10.1038/sj.bmt.1703715 DB - PRIME DP - Unbound Medicine ER -