SALVAGE AUTOLOGOUS OR ALLOGENEIC TRANSPLANTATION FOR MULTIPLE-MYELOMAREFRACTORY TO OR RELAPSING AFTER A FIRST-LINE AUTOGRAFT

Forty-two patients allografted for multiple myeloma after not having a ttained at least a partial remission (n = 19) Or after having experien ced disease progression (n = 23) following one autograft were compared with 42 pair-matched controls who underwent salvage autotransplantati on under identical conditions. Autografted controls were matched close ly for albumin, C-reactive protein, creatinine, disease sensitivity, d uration of standard therapy prior to the first transplant, Ig isotype, karyotype, LDH, and response to the first transplant, but, in compari son to allografted patients, were older, had higher beta 2-microglobul in, and had a shorter interval between the two transplants. The comple te remission rate was 41% after allogeneic and 33% after autologous tr ansplantation (P = NS). The 3-year probability of event-free survival was comparable for the two groups (25 +/- 8% after autografting and 20 +/- 8% after allografting). The 3-year probability of survival was si gnificantly higher after autologous transplantation (54 +/- 8% vs 29 /- 9%; P = 0.01). Twenty-one patients in the autograft group were aliv e 11-59 months (median 32) following the second transplant, while 15 p atients in the allograft group were alive at 10-53 months (median 20). The 3-year probability of disease progression was significantly lower after allogeneic transplantation (31 +/- 10% vs 72 +/- 9%, P = 0.03). The 1-year probability of transplant-related mortality was significan tly higher after allografting (43 +/- 8% vs 10 +/- 5%; P=0.0001). We c onclude that while autografting appears to be superior to allografting for salvage therapy of myeloma persisting or relapsing after one prev ious autotransplant in terms of overall survival, event-free survival is comparable due to significantly lower disease progression after all ografting. Reduction in allograft-related toxicity can potentially imp rove the results of allogeneic transplantation significantly.