REDUCED PROGRESSION-FREE SURVIVAL IN ELDERLY PATIENTS RECEIVING INTENSIFICATION WITH AUTOLOGOUS PERIPHERAL-BLOOD STEM-CELL REINFUSION FOR MULTIPLE-MYELOMA

Between 1990 and 1997, 55 patients with high risk multiple myeloma und erwent high-dose therapy with peripheral blood stem cell transplantati on. Intensification consisted of high-dose L-PAM in 54 patients, and 1 5 patients underwent a second high-dose treatment. Thirty patients rec eived total body irradiation. Twenty patients were more than 60 years old. Thirty-five patients were intensified during first response. The overall response rate was 78%, There were four toxic deaths. The media n overall survivals after intensification and after first treatment of myeloma were greater than 48 months and 71 months, respectively, Conv ersely freedom from progression after intensification was short, with a median of 22 months. Freedom from progression was significantly shor ter in patients older than 60 (12 months), and in patients who had rec eived more than 75 mg/m(2) of L-PAM before intensification (16 months) . Although intensification is feasible in elderly patients the benefit appears to be reduced in this subgroup of patients. Prior therapy wit h high cumulative doses of L-PAM should be avoided in patients who wil l receive high-dose L-PAM for therapeutic intensification.