Early harvest and late transplantation as an effective therapeutic strategy in multiple myeloma

Transplantation after high-dose chemotherapy prolongs survival in patients with multiple myeloma compared with standard therapy, It is unclear whether the optimal timing of transplantation is immediately after induction chemo therapy or whether stem cells may be cryopreserved for transplantation at s ubsequent progression or relapse. In this study, stem cells were collected within 6 months of diagnosis, followed by transplantation only at progressi on of myeloma, One hundred and eighteen patients with multiple myeloma had stem cells collected and cryopreserved. Eleven had transplants early in the disease after they demonstrated failure to respond to primary therapy. The remaining 107 were eligible for transplants when there was evidence of pro gressive disease. Of the 118 patients, 67 had transplants, nine died of pro gressive disease before transplantation, and 42 remain alive in plateau pha se. The median survival of the group is 58.5 months; 67 are alive. Serum be ta(2)-microglobulin, bone marrow labeling index (S phase), and hemoglobin l evel predicted overall survival (P < 0.006, P < 0.001, and P < 0.01, respec tively). We conclude that early cryopreservation of blood stem cells follow ed by transplantation at progression is a feasible approach to therapy in p atients with myeloma, The underlying biology of the disease has a greater i mpact on survival than the timing of transplantation. A prospective randomi zed trial is required to answer definitively the question of the optimal ti ming of blood cell transplantation.