HIGH-DOSE THERAPY FOLLOWED BY AUTOLOGOUS HEMATOPOIETIC STEM-CELL INFUSION FOR PATIENTS WITH MULTIPLE-MYELOMA

Purpose: To evaluate the outcome of patients with multiple myeloma (MM ) who received high-dose therapy followed by autologous bone marrow (B M) or peripheral-blood stem-cell (PBSC) infusion. Patients and Methods : Sixty-three consecutive patients with MM received autologous BM (n = 13) or PBSC with or without BM (n = 50) following regimens that conta ined busulfan (Bu) and cyclophosphamide (Cy) (n = 18), modified total- body irradiation (TBI) followed by Bu and Cy (n = 36), or Bu, melphala n, and thiotepa (n = 9). Two thirds of the patients had resistant dise ase and 69% had received more than 6 months of previous chemotherapy. Results cmd Conclusion: Recovery of peripheral-blood cell counts was m ore rapid in patients who received PBSC more with or without BM than i n patients who received BM alone. Sixteen of 63 patients (25%) died of complications of treatment within 100 days. Nineteen (40%) of 48 asse ssable patients achieved a complete response (CR), 23 (48%) had a part ial response (PR), and six (12%) had no response. The probabilities of survival and survival without relapse or progression for all 63 patie nts at 3.0 years were .43 and .21, respectively. The probability of re lapse or progression at 3 years was .69, and .17 patients (27%) have d ied of progressive MM. The probabilities of survival and relapse-free survival at 3 years for the 19 patients who achieved a CR were .42 and .17, respectively. In the multivariate analysis, beta(2)-microglobuli n levels more than 2.5 mu g/mL, more than two regimens of prior therap y and eight cycles of treatment, time to transplant longer than 3 year s from diagnosis, and prior radiation were associated with adverse out comes. Additional strategies, such as intervention earlier in the dise ase course, improved treatment regimens, sequential high-dose treatmen ts, and posttransplant therapies may improve outcome of selected patie nts with MM. (C) 1996 by American Society of Clinical Oncology.