High-dose therapy autotransplantation/intensification vs continued standard chemotherapy in multiple myeloma in first remission. Results of a non-randomized study from a single institution

The purpose of this study was to analyze the outcome of patients with multi ple myeloma (MM) responding to initial chemotherapy who received intensific ation with high-dose therapy/autotransplantation (HDT) as compared to that of those who were continued on standard chemotherapy. From 1 January 1990 t o 30 June 1998, 64 patients with MM who were younger than 65 years achieved a response to initial chemotherapy. Due to referral reasons, patients pref erence or inclusion in trials, 31 patients received HDT as early intensific ation while 33 were continued on standard chemotherapy. The presenting feat ures were similar in both groups, except for the median age, which was lowe r in the HDT group (53 vs 58 years, P = 0.007). Complete response negative immunofixation - (CR) was achieved in 12 of 31 (39%) patients intensified w ith HDT and in two of 33 (6%) patients who were continued on conventional c hemotherapy (P = 0.002). Event-free survival (EFS) was significantly longer in the HDT group (median, 43 vs 21 months; P = 0.007). Overall survival (O S) was not significantly different between groups (median, 62 vs 38 months; P = 0.,21). However, patients in the HDT group who achieved CR had an EFS (median, 51 vs 31 months; P = 0.03) as well as an OS (median, not reached v s 50 months; P = 0.0006) significantly longer than those achieving a lower degree of response. In conclusion, this non-randomized study shows that ear ly HDT increases CR rate and prolongs EFS. In addition, these results highl ight CR as a crucial step for achieving long-lasting disease control and pr olonged survival in patients with MM.