Korean J Hematol.  2006 Mar;41(1):36-40. 10.5045/kjh.2006.41.1.36.

Pre-transplant Disease Status is Important for an Improved Outcome of the Second Stem Cell Transplantation in the Myeloma Patients Receiving the First Autologous Stem Cell Transplantation

• Eom KS
• Min CK
• Lee S
• Kim YJ
• Kim SY
• Cho SG
• Lee JW
• Min WS
• Kim CC

• KMID: 2252325
• DOI: http://doi.org/10.5045/kjh.2006.41.1.36

Abstract

BACKGROUND: Double autologous stem cell transplantation (ASCT) seems to be superior to a single ASCT, at least in the patients who did not achieve a 90% response after the first transplant. An allogeneic SCT with a dose-reduced conditioning regimen after ASCT and as part of the initial therapy, might be a feasible and highly effective approach. The aim of this study was to determine the prognostic factors that are associated with the outcome of multiple myeloma (MM) patients who had received a second transplant.
METHODS
From April 1996 to December 2004, 38 MM patients, who had previously received high-dose melphalan (200 mg/m2) with autologous stem cell support, underwent a second transplant. Following the 1(st) ASCT, 24 patients received a second ASCT and 14 received a tandem reduced-intensity conditioning allogeneic stem cell transplantation (RIST) from their HLA-matched siblings.
RESULTS
The 3-year estimated PFS and overall survival (OS) from the time of the first ASCT were 25.2% and 77.6%, respectively. The median PFS and OS were 26 months (95% CI, 23~29) and 60 months (95% CI, 44~76), respectively. The disease status (a CR vs. PR or less) at the second transplant was be the most powerful factor for improving the PFS (P=0.001, hazard ratio 5.8, 95% CI 2.1~16.1).
CONCLUSION
Patients whose disease is sensitive to chemotherapy and who obtain a CR after a single transplantation might benefit the most from a second transplant.

Keyword

Multiple myeloma; Tandem stem cell transplantation; Reduced-intensity allogeneic transplantation; Autologous stem cell transplantation

MeSH Terms

Drug Therapy
Humans
Melphalan
Multiple Myeloma
Siblings
Stem Cell Transplantation*
Stem Cells*
Melphalan

Figure

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  Fig. 1 Progression-free survival of all patients (n=38) who received the first autologous stem cell transplant according to the disease status prior to the second transplant.

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  Fig. 2 Progression-free survival of patients (A; n=14) who received the reduced-intensity conditioning allogeneic stem cell transplantation and those (B; n=24) who underwent the autologous stem cell transplant according to the disease status before the second transplant.

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