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Complete remission status before autologous stem cell transplantation is an important prognostic factor in patients with multiple myeloma undergoing upfront single autologous transplantation.

Authors
 Jin Seok Kim  ;  Kihyun Kim  ;  June-Won Cheong  ;  Yoo Hong Min  ;  Cheolwon Suh  ;  Hawk Kim  ;  Deog Yeon Jo  ;  Hun Mo Ryoo  ;  Sung Soo Yoon  ;  Jae Hoon Lee 
Citation
 BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION, Vol.15(4) : 463-470, 2009 
Journal Title
 BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION 
ISSN
 1083-8791 
Issue Date
2009
MeSH
Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/administration & dosage ; Dexamethasone/administration & dosage ; Disease-Free Survival ; Doxorubicin/administration & dosage ; Female ; Follow-Up Studies ; Humans ; Internet ; Korea ; Male ; Middle Aged ; Multiple Myeloma/mortality ; Multiple Myeloma/therapy* ; Peripheral Blood Stem Cell Transplantation* ; Remission Induction ; Retrospective Studies ; Survival Rate ; Transplantation Conditioning ; Transplantation, Autologous ; Vincristine/administration & dosage
Keywords
Multiple myeloma ; Complete remission ; Prognostic factor ; Overall survival ; Autologous stem cell transplantation
Abstract
Upfront high-dose myeloablative chemotherapy followed by a single autologous stem cell transplantation (ASCT) is the standard therapy for patients under the age of 65 years with newly diagnosed multiple myeloma (MM). Because disease status after induction chemotherapy is variable, we evaluated the prognostic effect of disease status before ASCT, especially in patients who were initially chemosensitive. We retrospectively analyzed the initially chemosensitive MM patients (> or = partial remission [PR]) enrolled in the Korean Multiple Myeloma Working Party Web-based registration system (www.myeloma.or.kr). Between November 1996 and January 2007, 197 MM patients (median age 53 years) were treated with induction chemotherapy followed by a single ASCT. All patients received peripheral blood stem cell (PBSC) support after conditioning with melphalan (Mel) alone. We considered those patients with no detectable M-protein regardless of the result of immunofixation to be in complete remission (CR) in this study. The median follow-up times were 29.2 months (range, 5.4 to 103.8 months) from the day of diagnosis and 22.4 months (range, 0.4 to 96.0 months) from the day of ASCT. Before ASCT, 63 patients (32%) were in CR and 134 (68%) were in partial remission (PR). The patients in CR had significantly longer overall survival (OS) from the day of ASCT compared with those in PR (P = .0015). Among the patients who received induction chemotherapy with vincristine, adriamycin, and dexamethasone (n = 162), the same difference in OS was seen between those in CR and those in PR before ASCT (P = .0016). CR after ASCT also predicted longer OS (P = .0135); however, patients with continued CR after ASCT had significantly higher OS after ASCT compared with patient with induced CR after ASCT who were in PR before ASCT (P = .0178). Multivariate analysis indicated that remission status pre-ASCT (CR vs PR) is a significant prognostic factor for predicting OS after ASCT (P = .012, Cox proportional hazard analysis; odds ratio = 2.83; 95% confidence interval = 1.25 to 6.37). We conclude that patients with MM who are in CR before ASCT have a better OS than those in PR before ASCT. Continued CR after ASCT may be an important prognostic factor as well. Our findings suggest that the development of more effective induction regimens, including novel antimyeloma agents to improve initial response, should be pursued to enhance clinical benefits post-ASCT.
Full Text
http://www.sciencedirect.com/science/article/pii/S1083879109000056
DOI
10.1016/j.bbmt.2008.12.512
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jin Seok(김진석) ORCID logo https://orcid.org/0000-0001-8986-8436
Min, Yoo Hong(민유홍) ORCID logo https://orcid.org/0000-0001-8542-9583
Cheong, June-Won(정준원) ORCID logo https://orcid.org/0000-0002-1744-0921
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/104794
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