engleski

Tandem transplantation in multiple myeloma – single center experience

High-dose chemotherapy followed by autologous hematopoetic stem cell transplantation is well established first line therapy for multiple myeloma. It has been previously shown that tandem transplantation carries survival benefit when compared to a single transplantation. We have conducted a trial of two successive high-dose chemotherapy followed by peripheral blood stem cell rescue for patients with advanced stage multiple myeloma. Aim Aim was to evaluate feasibility, efficacy and toxicity of tandem transplantation. Patients and Methods We included 107 patients, median age 54 years (32-66), 49 were female, and 58 male patients. Most of the patients had IgG monoclonal protein (54.2%), 17.7% patients had IgA monoclonal protein, 17.7% had light chain myeloma, while 9.3% had non-secretory myeloma, and one patient had IgD monoclonal protein. Patients were evaluated on a intention to treat basis, and from 107 included patients, 83 (77.5%) received tandem transplantation ; 4 patients did not collect adequate number of cells for two transplantations, 10 patients had low performance score, 7 were not transplanted due to physician decision, 1 patient refused second transplantation, 1 patient relapsed and for 1 patient the reason is unknown. Results Progression free survival (PFS) and overall survival (OS) were evaluated. Median time of progression free survival for the entire group was 77 months, while median time of overall survival was 138 months. Prior to first transplantation 8.6% of patients were in complete remission or very good partial remission (CR/VGPR), 78% were in partial remission (PR) and 11.4% had minimal response, while 1.9% had progressive disease. After the first transplantation 42.3% achieved CR/VGPR and 50% of patients were in PR, while after the second transplantation 71.8% of patients were in CR/VGPR and 26.2% were in PR. We conducted analysis of PFS and OS according to disease status prior to second transplantion and found no significant difference between patients that achieved CR or VGPR and the patients that did not do so. However, when the same analysis was done according to disease status 6 months after the second transplantation, a significant difference in both PFS and OS was found between patients that achieved CR/VGPR and the patients that did not achieve CR/VGPR (p=0.0179 and p=0.0056 respectively). Conclusion Tandem transplantation as first line treatment for multiple myeloma is an effective therapy offering patients long term progression free survival and overall survival. We found no significant difference in long term PFS and OS between patients that achieved CR/VGPR prior to second transplantation and those that did not, indicating important therapy efficacy of second transplantation. Also, patients achieving CR/VGPR after second transplantation have statistically better PFS and OS than patients failing to do so, which emphasizes importance of achieving CR as a final outcome.

tandem transplantation ; multiple myeloma

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