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KOS 2007: Debate II - Should autologous transplant be part of the primary treatment in MM? NO
By Jean-Paul Fermand, MD
Jean-Paul Fermand, MD
Department of Immuno-Hematology
Hopital Saint-Louis, France

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Department of Immuno-Hematology
Hopital Saint-Louis, France

Present standard of care for young patients with multiple myeloma (MM) is high dose therapy (HDT) with autotransplantation using blood as the source of autologous stem cells. This therapeutic approach can produce long-term survival (19% of the patients that we treated between 1985 and 1990, now with a median 15.8 year follow-up). In addition, it has been demonstrated to significantly prolong survival when compared with standard dose therapy (SDT) in prospective randomised trials conducted by French (IFM), English (MRC) and Italian groups (1-3).However, the situation is somewhat more complex. Indeed, in other randomised studies, namely a large US study, our MAG 91 study and the study of the Spanish group Pethema, superiority of HDT over SDT in terms of overall survival (OS) was not demonstrated (4-6). The very nature of these contradictory data indicates that large numbers of patients would need to be studied to demonstrate the potential advantage of HDT and suggest that the improvement in survival, if any, is of limited duration.

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