"We found that the complete remission rate was significantly higher in the allogeneic arm."
Dr. Joan Bladé
To view the video full screen, click on the small button next to the volume control in the lower right hand corner. Tandem Autologous Transplant Versus Reduced Intensity Conditioned Allogeneic Transplant (Allo-RIC) as Second Intensification in Chemosensitive Patients with Multiple Myeloma (MM) Not Achieving Complete Remission (CR) or Near-CR with a First Autologous Transplant. Results from a Spanish PETHEMA/GEM Study. Session Type: Oral Session
Joan Blade, Laura Rosinol, Juan Jose Lahuerta, Anna Sureda, Javier de la Rubia, Jose Garcia-Larana, Miguel Hernandez-Garcia, Belen Hernandez-Ruiz, Jose Antonio Perez-Simon, Jose Luis Bello, Dolores Carrera, Maria Jesus Penarrubia, Eugenia Abella, Angel Leon, Concepcion Poderos, Juan Carlos Garcia-Ruiz, Joan Besalduch, Rafael Martinez-Martinez, Isabel Perez-Fernandez, Paz Ribas, Jesus San Miguel Hematology, Hospital Clinic, Barcelona, Spain; Hematology, H. 12 de Octubre, Madrid, Spain; Hematology, H. Sant Pau, Barcelona, Spain; Hematology, H. La Fe, Valencia, Spain; Hematology, H. Ramon y Cajal, Madrid, Spain; Hematology, H.U. Canarias, Sta Cruz Tenerife, Spain; Hematology, H. Ntra Sra Alarcos, Ciudad Real, Spain; Hematology, H.Clinico, Salamanca, Spain; Hematology, H.C.U. Santiago, Santiago Compostela, La Coruna, Spain; Hematology, H. Asturias, Oviedo, Asturia, Spain; Hematology, H. del Rio Hortega, Valladolid, Spain; Hematology, H. del Mar, Barcelona, Spain; Hematology, H. General Jerez de la Frontera, Jerez de la Frontera, Cadiz, Spain; Hematology, H. Xeral-Cies, Vigo, Pontevedra, Spain; Hematology, H. Cruces, Baracaldo, Vizcaya, Spain; Hematology, H. Son Dureta, Palma Mallorca, Spain; Hematology, H. Clinico Madrid, Madrid, Spain; Hematology, H. Virgen de la Victoria, Malaga, Spain; Hematology, H. Doctor Peset, Valencia, Spain
One randomized trial showed that tandem transplant resulted in a significantly longer EFS and OS in patients failing to achieve CR or near-CR with a single transplant. However, other studies failed to show benefit from a second transplant. The aim of our study was to investigate the efficacy in terms of response improvement and survival from a second transplant intensification in patients with chemosensitive disease who failed to achieve CR or near-CR with a first high-dose procedure. Patients diagnosed with MM from Oct 1999 to Dec 2004 younger than 70 years received 6 courses of VBMCP/VBAD and responding patients were intensified with busulphan/melphalan or MEL-200 followed by stem cell support. Patients not achieving CR or near-CR were planned to undergo a second transplant (second auto with CVB - cyclophosphamide, etoposide and BCNU or MEL-200 intensification or an allo-RIC with Fludarabine/MEL-140 conditioning, if sibling donor available). Eighty-eight patients received a second autologous transplant while 26 underwent an allo-RIC. Thirty-seven percent of the patients given a second autologous transplant improved their response status (CR 11%, near-CR: 6%, PR: 9% and MR 11%) while 63% showed no change, progressive disease or early death. A response was observed in 45% of patients undergoing the allo-RIC (CR: 33%, PR: 4%, MR: 8%). The CR rate was significantly higher with allo-RIC (33% vs. 11%, p= 0.02). There was a trend towards a higher TRM with the allo-RIC (5% vs. 16%, p=0.09). Although the median EFS (26 vs 19 m) and OS (57 m vs not reached in allo-RIC) from the second high-dose procedure were not significantly different, there is a plateau in the allo-RIC group beyond 3 years of the second procedure not observed in the autologous arm. Conclusions:1) an allo-RIC transplant after an autologous procedure results in a significantly higher CR rate than a second autologous transplant, and 2) despite the lack of significant differences in survival between the two transplant modalities, there is a plateau in the allogeneic group not observed in the autologous arm.
Abstract #729 appears in Blood, Volume 110, issue 11, November 16, 2007
Keywords: Multiple Myeloma|Transplant|Reduced Intensity Transplantation
Disclosure: No relevant conflicts of interest to declare.
Tuesday, December 11, 2007 8:00 AM
Session Info: Simultaneous Session: Autologous Transplantation for Plasma Cell Disorders: Transplant Regimens (7:30 a.m.-9:00 a.m.)