ALLOGENEIC BONE-MARROW TRANSPLANTATION VERSUS AUTOLOGOUS STEM-CELL TRANSPLANTATION IN MULTIPLE-MYELOMA - A RETROSPECTIVE CASE-MATCHED STUDYFROM THE EUROPEAN GROUP FOR BLOOD AND MARROW TRANSPLANTATION

A retrospective case-matched analysis was performed comparing 189 myel oma patients treated with allogeneic bone marrow transplantation (allo -BMT) with an equal number of patients who received autologous stem ce ll transplantation (ASCT). Matching was performed with respect to gend er and number of treatment lines before transplantation. The groups we re comparable with the exception of median age (43 years for allo-BMT v 49 years for ASCT, P = .0001) and median posttransplant follow-up (4 6 months for allo-BMT v 30 months for ASCT, P = .0003). The overall su rvival was significantly better for ASCT than for allo-BMT, with a med ian survival of 34 months and 18 months, respectively (P = .001). Howe ver, this survival advantage was only observed in men, but not in wome n. The statistically significant survival advantage for ASCT was seen in most subgroups, ie, chemotherapy-responsive patients, patients who had received two or more treatment lines before transplantation, patie nts in partial remission, patients with an IgG-subtype, patients older than 46 years of age, patients with stage II disease, and patients wi th a low or high serum-beta-2-microglobulin at diagnosis. The main rea son for the poorer survival in allo-BMT patients was higher transplant -related mortality (41% v 13% for ASCT, P = .0001), which was not comp ensated for by a lower rate of relapse and progression. However, in pa tients alive at 1 year posttransplant, there was a trend for better lo ng-term survival (P = .09) and significantly better progression-free s urvival (P = .02) for allo-BMT as compared with ASCT. We conclude that the median survival is superior for ASCT. However, allo-BMT has a low er relapse rate, which results in a similar long-term outcome for both approaches, but a longer follow-up is needed to assess the final outc ome. (C) 1996 by The American Society of Hematology.