Two stem-cell grafts improve survival after high-dose chemo for multiple myeloma

Following high-dose chemotherapy for multiple myeloma, performing two autologous stem-cell transplants (rather than one) doubles long-term survival, French physicians report. The benefit offered by double transplantation appears to be mediated by prolonged duration of response to treatment.

After high-dose chemotherapy, stem-cell transplantation is recommended for young patients with multiple myeloma, either as initial treatment or at the time of disease progression, members of the InterGroupe Francophone du Myelome note in the December 25th issue of the New England Journal of Medicine. Even so, the median duration of response is less than 3 years.The group, led by Dr. Michel Attal, at Hopital Purpan in Toulouse, enrolled 399 patients between 1994 and 1997, who were randomly assigned to one or two stem-cell transplants. Grafting was performed after initial treatment with vincristine, doxorubicin and dexamethasone.Assigned therapy was delivered to 170 patients in the single transplant group and 165 in the double transplant group. Complete or very good partial responses were documented for 84 (49%) and 99 (63%), respectively (p = 0.01). In the intent-to-treat analysis, though, response rates did not differ significantly.During a median follow-up of 75 months, relapse-free survival was 29 and 36 months, respectively, in the single and double transplant groups; overall survival was 48 and 58 months. The probability of survival for 7 years was 21% after a single transplant and 42% after double transplants (p = 0.01). Once relapse occurred survival rates were similar, regardless of treatment.”Patients who did not have at least a very good partial response after the first procedure had a significant benefit from the second transplantation” (p < 0.001), the authors write. A second transplantation did not benefit those whose initial response was good."This report establishes double transplantation as one of the options for treating patients who have myeloma, particularly those younger than 60 years of age who have a suboptimal response to a single transplant," Dr. Edward A. Stadtmauer, at the University of Pennsylvania in Philadelphia, says in a related editorial. (Source: N Engl J Med 2003;349:2495-2593: Reuters Health: December 24, 2003: Oncolink)