Long-term outcome results of the first tandem autotransplant trial for multiple myeloma

被引:126
作者
Barlogie, Bart
Tricot, Guido J.
van Rhee, Frits
Angtuaco, Edguardo
Walker, Ron
Epstein, Joshua
Shaughnessy, John D.
Jagannath, Sundar
Bolejack, Vanessa
Gurley, Jennifer
Hoering, Antje
Vesole, David
Desikan, Raman
Siegel, David
Mehta, Jayesh
Singhal, Seema
Munshi, Nikhil C.
Dhodapkar, Madhav
Jenkins, Bonnie
Attal, Michel
Harousseau, Jean-Luc
Crowley, John
机构
[1] Univ Arkansas Med Sci, Myeloma Inst Res & Therapy, Little Rock, AR 72205 USA
[2] St Vincents Comprehens Canc Ctr, New York, NY USA
[3] Canc Res & Biostat, Seattle, WA USA
[4] Arkansas Oncol Assoc, Little Rock, AR USA
[5] Hackensack Univ, Ctr Med, Hackensack, NJ USA
[6] Northwestern Univ, Myeloma Program, Chicago, IL USA
[7] Dana Farber Canc Inst, Boston, MA 02115 USA
[8] Rockefeller Univ, New York, NY 10021 USA
[9] Hop Purpan, Toulouse, France
[10] CHU Hotel Dieu, Hematol Clin, Nantes, France
关键词
myeloma; high-dose melphalan; prognosis;
D O I
10.1111/j.1365-2141.2006.06271.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Total Therapy 1, the first tandem autotransplant trial for newly diagnosed patients with multiple myeloma, was designed to increase the frequency of complete response (CR) and thereby extend survival. With a median follow-up of 12 years, 62 of 231 initially enrolled patients are alive (17% at 15 years); 31 remain event free (7% at 15 years) including 16 of 94 (41%) that initially achieved CR. Currently alive patients less frequently had cytogenetic abnormalities (CAs) at baseline (P = 0.002), postenrolment (P < 0.001) and at relapse (P = 0.004); elevations of serum C-reactive protein (CRP) (P = 0.003) and lactate dehydrogenase (P = 0.029), anaemia (P = 0.029) and they more often completed two transplants within 12 months (P = 0.019). Postenrolment overall survival (OS) and event-free survival (EFS) were superior in the absence of CA of the hypodiploidy or deletion 13 variety (P < 0.001 and 0.037 respectively) and in the presence of low CRP at baseline (P = 0.001 and 0.017 respectively). Postrelapse survival was longer in the absence of CA at relapse (P < 0.001), IgA isotype (P = 0.002), International Staging System stage 3 (P = 0.014), and when patients had two protocol transplants prior to relapse (P = 0.038). Ten-year EFS and OS could be accomplished in 15% and 33% of patients, respectively, when all agents available in 1989, especially high-dose melphalan, were applied together upfront for the management of myeloma.
引用
收藏
页码:158 / 164
页数:7
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