Autologous stem cell transplantation in multiple myeloma: Results of the european group for bone marrow transplantation

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Abstract
Autologous hematopoietic stem cell transplantation was used for treatment of 384 patients with multiple myeloma in 37 centers during the years 1986–1994. An analysis of prognostic factors was performed in 207 of these patients. One hundred forty one were males and 66 females, and median age was 49 years (range, 24–68). Actuarial survival at 78 months is 45%. Factors associated with a good prognosis were: response on chemotherapy immediately pretransplant, administration of only one treatment regimen, a low serum‐β2‐Microglobulin value at diagnosis and the use of a conditioning regimen including melphalan. In a multivariate analysis, response status pretransplant, age <45 years, melphalan conditioning and non‐TBI conditioning were independently predictive for longer survival, while transplantation after only one line of primary treatment and isotype other than light‐chain were of borderline significance. Post‐transplant alpha‐interferon treatment was associated with improved survival in responsive patients. Eighteen patients treated in one center (Huddinge) passed a double autograft program, and 14 are in continuous complete remission ([CR]; n = 10) or good partial remission (n = 4) at a median time of 17 months after the first transplant (range, 2–38). In five CR patients, polymerase chain reaction (PCR)‐analysis of the clone‐specific immunoglobulin‐rearrangement was performed, and four are PCR‐negative up to 33+ months after the first transplantation. We conclude that autografting in myeloma is most effective when applied early in the course of disease in younger, chemotherapy‐responsive patients. Alpha‐interferon maintenance treatment seems to be beneficial with respect to improved survival. Repeated cycles of high‐dose chemo‐radiotherapy with autologous stem cell rescue can induce a very high response rate, where the absence of minimal residual disease in CR patients has been demonstrated by the highly sensitive PCR‐technique.