Impact of pretransplant therapy and depth of disease response before autologous transplantation for multiple myeloma.
Patients with multiple myeloma (MM) who are eligible for autologous stem cell transplantation (ASCT) typically receive a finite period of initial therapy before ASCT. It is not clear if patients with suboptimal (less than a partial) response to initial therapy benefit from additional alternative therapy with intent to maximize pretransplant response. We identified 539 patients with MM who had an ASCT after having achieved less than a partial response (PR) to first-line induction chemotherapy between 1995 and 2010. These patients were then divided into 2 groups: those who received additional salvage chemotherapy before ASCT (n = 324) and those who had no additional salvage chemotherapy immediately before ASCT (n = 215). Additional pretransplant chemotherapy resulted in deepening responses in 68% (complete response in 8% and PR in 60%). On multivariate analysis there was no impact of pretransplant salvage chemotherapy on treatment-related mortality, risk for relapse, progression-free survival, or overall survival. In conclusion, for patients achieving less than a PR to initial induction therapy, including with novel agent combinations, additional pre-ASCT salvage chemotherapy improved the depth of response and pre-ASCT disease status but was not associated with survival benefit.
['Vij|Ravi|R|', 'Kumar|Shaji|S|', 'Zhang|Mei-Jie|MJ|', 'Zhong|Xiaobo|X|', 'Huang|Jiaxing|J|', 'Dispenzieri|Angela|A|', 'Abidi|Muneer H|MH|', 'Bird|Jennifer M|JM|', 'Freytes|César O|CO|', 'Gale|Robert Peter|RP|', 'Kindwall-Keller|Tamila L|TL|', 'Kyle|Robert A|RA|', 'Landsburg|Daniel J|DJ|', 'Lazarus|Hillard M|HM|', 'Munker|Reinhold|R|', 'Roy|Vivek|V|', 'Sharma|Manish|M|', 'Vogl|Dan T|DT|', 'Wirk|Baldeep|B|', 'Hari|Parameswaran N|PN|']
D000293:Adolescent D000328:Adult D000368:Aged D000971:Antineoplastic Combined Chemotherapy Protocols D016903:Drug Monitoring D005260:Female D018380:Hematopoietic Stem Cell Transplantation D006801:Humans D060828:Induction Chemotherapy D008297:Male D008875:Middle Aged D009101:Multiple Myeloma D012074:Remission Induction D012189:Retrospective Studies D016879:Salvage Therapy D016019:Survival Analysis D019172:Transplantation Conditioning D014182:Transplantation, Autologous D016896:Treatment Outcome
Autologous transplant Myeloma Primary refractory