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Bone Marrow Transplant. 2015 Apr;50(4):505-10. doi: 10.1038/bmt.2014.310. Epub 2015 Jan 26.

Impact of CR before and after allogeneic and autologous transplantation in multiple myeloma: results from the EBMT NMAM2000 prospective trial.

Author information

1
Centro Interdipartimentale di Biostatistica e Bioinformatica, Università di Roma 'Tor Vergata', Rome, Italy.
2
Department of Biostatistics and Bioinformatic, Leiden University Medical Center, Leiden, The Netherlands.
3
Department of Medicine V, University Hospital of Heidelberg, Heidelberg, Germany.
4
Hematology Center/Huddinge, Karolinska University Hospital, Stockholm, Sweden.
5
Department of Medicine, Karolinska Institute at Huddinge and Solna, Stockholm, Sweden.
6
Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
7
Helsinki University Central Hospital, Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland.
8
Department of Oncology Hematology & Respiratory Diseases, AOU Policlinico Modena, University of Modena, Modena, Italy.
9
Department of Hematology and Stem Cell Transplant Unit, CSS Hospital IRCCS, S.G. Rotondo, Italy.
10
Department of Hematology, Ankara University Faculty of Medicine, Ankara, Turkey.
11
Department of Haematology, University of Florence, Careggi Hospital, Florence, Italy.
12
Department of Haematology, Ospedale Ferrarotto, Catania, Italy.
13
Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milano, Milano, Italy.
14
Department of Tumor Immunology, Nijmegen Institute of Life Sciences, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
15
Department of Haematology, The Queens University, Belfast, UK.
16
Division of Hematology and Medical Oncology, University Hospital Leipzig, Leipzig, Germany.
17
Département d'hématologie et de thérapie cellulaire, Hopital St Antoine, Paris, France.
18
Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany.

Abstract

Previous studies have shown that obtaining complete hematologic remission (CR) in multiple myeloma is an important predictor of PFS and OS. This applies both to autologous and allogeneic transplantation. However, the importance of CR obtained before vs after second transplant or following allogeneic vs autologous transplantation is not clear. We investigated the role of CR analyzing data from the EBMT-NMAM2000 interventional prospective study comparing tandem autologous/reduced intensity conditioning allogeneic transplantation (auto/RICallo) to autologous transplantation-single or double (auto/auto). Allocation to treatment was performed according to availability of a matched sibling donor. Cox regression and multi-state models were applied. The long-term probability of survival in CR was superior in auto/RICallo, both comparing groups according to treatment allocated at start (28.8 vs 11.4% at 60 months, P=0.0004) and according to actual administration of second transplant (25.6 vs 9.6% at 60 months, P=0.008). CR achieved before the second transplant was predictive for PFS (hazard ratio (HR)=0.44, P= 0.003) and OS (HR 0.51, P=0.047) irrespective of the type of second transplant. CR achieved after auto/RICallo was more beneficial for PFS (HR=0.53, P=0.027) than CR after auto/auto (HR=0.81, P=0.390), indicating a better durability of CR obtained after an allotransplant procedure.

PMID:
25621805
DOI:
10.1038/bmt.2014.310
[Indexed for MEDLINE]

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