Background We conducted a randomized trial of the treatmentof multiple myeloma with high-dose chemotherapy followed byeither one or two successive autologous stem-cell transplantations.
Methods At the time of diagnosis, 399 previously untreated patientsunder the age of 60 years were randomly assigned to receivea single or double transplant.
Results A complete or a very good partial response was achievedby 42 percent of patients in the single-transplant group and50 percent of patients in the double-transplant group (P=0.10).The probability of surviving event-free for seven years afterthe diagnosis was 10 percent in the single-transplant groupand 20 percent in the double-transplant group (P=0.03). Theestimated overall seven-year survival rate was 21 percent inthe single-transplant group and 42 percent in the double-transplantgroup (P=0.01). Among patients who did not have a very goodpartial response within three months after one transplantation,the probability of surviving seven years was 11 percent in thesingle-transplant group and 43 percent in the double-transplantgroup (P<0.001). Four factors were significantly relatedto survival: base-line serum levels of beta2-microglobulin (P<0.01)and lactate dehydrogenase (P<0.01), age (P<0.05), andtreatment group (P<0.01).
Conclusions As compared with a single autologous stem-cell transplantationafter high-dose chemotherapy, double transplantation improvesoverall survival among patients with myeloma, especially thosewho do not have a very good partial response after undergoingone transplantation.
Source Information
From the Departments of Hematology and Biostatistics, Hôpital Purpan, Toulouse, France (M.A.); Hôtel Dieu, Nantes, France (J.-L.H., R. Bataille); Hôpital C. Huriez, Lille, France (T.F.); Centre Hospitalier la Mileterie, Poitiers, France (F.G.); Centre Universitaire Saint Luc, Brussells, Belgium (C.D.); Hôpital du Cimiez, Nice, France ( J.-G.F.); Centre Henri Becquerel, Rouen, France (M.M.); Centre Hospitalier Brabois, Nancy, France (C.H.); Centre Hospitalier Le Bocage, Dijon, France (D.C.); Institut Paoli Calmettes, Marseilles, France (R. Bouabdallah); Hôpital Jean Minjoz, Besançon, France (L.V.); Hôpital Albert Michallon, Grenoble, France (J.-J.S.); and Hôpital Sud, Rennes, France (B.G.).
Address reprint requests to Dr. Attal at the Service d'Hématologie, Hôpital Purpan, Place du Dr. Baylac, 31059 Toulouse, France, or at attal.m{at}chu-toulouse.fr.
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