Autologous transplantation in multiple myeloma: a GITMO retrospective analysis on 290 patients

Background and Objective. Autologous transplantation is a better treatment for multiple myeloma (MM) than chemotherapy, but uncertainty remains about patient selection, optimal timing of autograft, conditioning regimen, need for a second autograft, and role of maintenance. To provide partial answers to these questions we assessed the results of autologous transplantation i n a large cohort of patients whose data were reported to the GITMO registry . Design and Methods. We retrospectively analyzed data from 290 patients with MM (M=150; F=140; median age 52 years, range 19-70; stage I=34, stage II=7 5, stage III=167) reported to the GITMO. At the time of autograft, 20% were in CR, 66% in PR, while the remaining had non-responsive or progressive di sease. Median time between diagnosis and transplant was 16 months (1-90). S eventy-two patients (26%) had been planned to receive a double autograft, b ut this was actually done in only 35 (12%) The conditioning was chemotherap y in 90%. Peripheral blood was the only source of stem cells in 94%, and pu rging was applied in 10% of cases. For statistical analysis of data, differ ences between patient subsets were analyzed using the chi-square test, whil e the Kaplan-Meier method was used to estimate event-free survival (EFS) an d survival (OS) probabilities. The Cox model was used for multivariate anal ysis. Results. Following the autograft, 116 patients (40%) were in CR, 144 (50%) in PR, 24 (8%) did not respond or progressed and 6 (2%) died before respons e evaluation. Transplant-related mortality occurred in 3%. At a median foll ow-up of 23 months, 223 (77%) patients are alive, 71 (24%) of them in CR, a nd 67 (23%) patients have died at a median time of 20 months (0-70). OS and EFS at 6 years are 47% and 28%, respectively, but the EFS curve shows no p lateau. In multivariate analysis, age, beta(2)-microglobulin level and stat us at transplant emerged as significant prognostic factors for both OS and EFS, while time from diagnosis to transplant showed borderline significance . Interpretation and Conclusions. Based on the prognostic factors Identified In multivariate analysis, we were able to assess the weight of a single pro gnostic factor or their combinations an transplant outcome. We also calcula ted the probability of OS and EFS by the number of factors at the time of a utograft. Autologous transplantation is a safe and effective procedure, not only In sensitive patients, but also in resistant cases, provided they are <55 years of age and have low beta(2)-microglobulin, it should be applied early the diagnosis of multiple myeloma, following the delivery of brief pr imary chemotherapy. (C) 1999, Ferrata Storti Foundation.