Benefit from autologous stem cell transplantation in primary refractory myeloma? Different outcomes in progressive versus stable disease
Por:
Rosinol, L, Garcia-Sanz, R, Lahuerta, JJ, Hernandez-Garcia, M, Granell, M, de la Rubia, J, Oriol, A, Hernandez-Ruiz, B, Rayon, C, Navarro, I, Garcia-Ruiz, JC, Besalduch, J, Gardella, S, Jimenez, JL, Diaz-Mediavilla, J, Alegre, A, San Miguel, J, Blade, J
Publicada:
1 abr 2012
Resumen:
Background
Several studies of autologous stem cell transplantation in primary refractory myeloma have produced encouraging results. However, the outcome of primary refractory patients with stable disease has not been analyzed separately from the outcome of patients with progressive disease.
Design and Methods
In the Spanish Myeloma Group 2000 trial, 80 patients with primary refractory myeloma (49 with stable disease and 31 with progressive disease), i.e. who were refractory to initial chemotherapy, were scheduled for tandem transplants (double autologous transplant or a single autologous transplant followed by an allogeneic transplant). Patients with primary refractory disease included those who never achieved a minimal response (>= 25% M-protein decrease) or better. Responses were assessed using the European Bone Marrow Transplant criteria.
Results
There were no significant differences in the rates of partial response or better between patients with stable or progressive disease. However, 38% of the patients with stable disease at the time of transplantation remained in a stable condition or achieved a minimal response after transplantation versus 7% in the group with progressive disease (P=0.0017) and the rate of early progression after transplantation was significantly higher among the group with progressive disease at the time of transplantation (22% versus 2%; P=0.0043). After a median follow-up of 6.6 years, the median survival after first transplant of the whole series was 2.3 years. Progression-free and overall survival from the first transplant were shorter in patients with progressive disease (0.6 versus 2.3 years, P=0.00004 and 1.1 versus 6 years, P=0.00002, respectively).
Conclusions
Our results show that patients with progressive refractory myeloma do not benefit from autologous transplantation, while patients with stable disease have an outcome comparable to those with chemosensitive disease.
Filiaciones:
Rosinol, L:
Hosp Clin Barcelona, E-08036 Barcelona, Spain
Garcia-Sanz, R:
Hosp Clin Salamanca, Salamanca, Spain
Lahuerta, JJ:
Hosp Doce de Octubre, Madrid, Spain
Hernandez-Garcia, M:
Hosp Univ Canarias, Tenerife, Spain
Granell, M:
Hosp Santa Creu & Sant Pau, St Pau, Spain
Oriol, A:
Hosp Badalona Germans Trias & Pujol, Barcelona, Spain
Rayon, C:
Hosp Cent Asturias, Oviedo, Spain
Navarro, I:
Hosp Sagunto, Valencia, Spain
San Miguel, J:
Hosp Clin Salamanca, Salamanca, Spain
Blade, J:
Hosp Clin Barcelona, E-08036 Barcelona, Spain
Gold, Green Published
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