Abstract 3568

Introduction:

High dose chemotherapy with melphalan followed by autologous peripheral blood stem cell transplantation (PBSCT) is a standard treatment regimen for young patients with multiple myeloma. However, there are few studies, mainly with low patient counts, testing the benefit of the reapplication of high dose chemo therapy in relapsed or refractory myeloma.

Methods:

Here we retrospectively analyzed 178 patients (56% male, 44% female, median age 60 years) with relapsed or refractory myeloma who were treated by reapplying high dose chemotherapy with melphalan followed by autologous PBSCT in our institution over the last 18 years. The median follow up of this study was 54 months.

Result:

Median progression free survival (PFS) and overall survival (OS) after relapse autologous transplantation were 16 and 35 months, respectively. 66% of the patients received newer antimyeloma agents for reinduction therapy (39% thalidomide, 6% bortezomib, 21% lenalidomide). In univariate analysis, time between first transplantation and progression of disease had a significant impact on PFS and OS (p=0.001 and p<0.001). Estimated hazard ratio (HR) for prolongation of time to progression (TTP) after first transplantation of one year for PFS and OS are 0.85 and 0.73, respectively. The effect of TTP after first PBSCT on PFS and OS with respect to different clinically relevant cutoff values is illustrated in Table 1.

Table 1:

Impact of time to progression (TTP) after first autologous transplantation (TPL) on PFS and OS

PFSOS
TTP after first TPLHazard ratiop-valueHazard ratiop-value
<6 months: >6 months 1.29 0.58 2.60 0.04 
<12 months: >12 months 1.72 0.04 3.52 <0.001 
<18 months: >18 months 1.68 0.004 2.28 <0.001 
PFSOS
TTP after first TPLHazard ratiop-valueHazard ratiop-value
<6 months: >6 months 1.29 0.58 2.60 0.04 
<12 months: >12 months 1.72 0.04 3.52 <0.001 
<18 months: >18 months 1.68 0.004 2.28 <0.001 
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Conclusion:

Reapplication of high dose chemotherapy can be an effective treatment option for relapsed or refractory myeloma, in particular in patients with a time to progression after first autologous transplantation of more than one year.

Figure 1:
Figure 1:. Estimated progression free survival (PFS) and overall survival (OS) of multiple myeloma patients undergoing salvage high dose chemotherapy and autologous transplantation (TPL)
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Estimated progression free survival (PFS) and overall survival (OS) of multiple myeloma patients undergoing salvage high dose chemotherapy and autologous transplantation (TPL)

Figure 1:
Figure 1:. Estimated progression free survival (PFS) and overall survival (OS) of multiple myeloma patients undergoing salvage high dose chemotherapy and autologous transplantation (TPL)
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Estimated progression free survival (PFS) and overall survival (OS) of multiple myeloma patients undergoing salvage high dose chemotherapy and autologous transplantation (TPL)

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Disclosures:

No relevant conflicts of interest to declare.

Topics:
chemotherapy regimen, hematopoietic stem cell transplantation, melphalan, multiple myeloma, retreatments, salvage therapy, transplantation, autologous, time to progression, transplantation, bortezomib

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2010 by The American Society of Hematology
2010
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