Survival after relapse following tandem autotransplants in multiple myeloma patients: the University of Arkansas total therapy I experience

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Abstract
Summary. Despite the superiority of high‐dose (compared with standard) treatment in multiple myeloma, relapses still occur. We evaluated relapse patterns, salvage treatments employed and outcome in patients given tandem transplants on our total therapy I protocol. We focused on 146 patients (of 231 enrolled) who received tandem autotransplants ≤12 months apart and survived ≥2 months after the second transplant. With a median follow‐up of 9 years after enrollment, 31 (21%) patients remain in complete or stable partial remission. Ninety‐five (65%) patients received therapy for relapsing myeloma. The median time from the first transplant to relapse was 2·9 years. The median overall survival from relapse was 2·4 years. In one‐quarter (23/95) of cases, the postrelapse interval exceeded the interval from the first transplant to relapse. On multivariate analysis, the presence of any cytogenetic abnormalities [P < 0·001, Hazard Ratio (HR): 3·84] and β‐2 microglobulin levels > 4 mg/l at relapse (P < 0·001, HR: 2·87) were significant for poor survival after relapse. The median survival after relapse was 5·1, 1·3 and 0·7 years in patients with none (44%), one (46%) and two (10%) poor‐risk factors, respectively. In conclusion, a sizeable fraction of myeloma patients relapsing after tandem autotransplants without poor‐risk features enjoyed meaningful survival prolongation when appropriately treated.

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