Haematologica 2003 - Supplements

occurrence of second transplantation and the timing of this
intervention. A time-dependent multivariant Cox analysis shows
that for patients having a second transplant in first remission there
is a marked increase in the HR for TRM if the transplant is
performed after 12 months while the HR for relapse incidence is
not as beneficial as when the transplant is performed earlier. As
regards survival after relapse, performing a second transplant
after this event does not appear to provide an advantage, although
if the second transplantation was given before relapse there is an
increased HR. Further prospective studies of single and double
transplant strategies are required to identify the best therapeutic
stratagems for patients with myeloma.
290
Long-Term Event Free Survival (≥ 5 years) in Patients
with Myeloma Planned to Receive a Single
Autotransplant : Better or Comparable results
Compared to Tandem Autotransplants
Bhawna Sirohi, R Powles, S Singhal, S Sankpal, S
Kulkarni, R Saso, G Patel, C Horton, J Mehta
Royal Marsden NHS Trust
Between February 1985 and October 2001, 451 consecutive
myeloma patients received a single autotransplant conditioned
with high-dose melphalan 200mg/m2(Sirohi et al, Proc Am Soc
Clin Oncol 2002; 21:269a). For this study, only those patients
transplanted ≥ 5 years prior to the date of analysis (26 April
2002) were included (n=266). The median age of patients was 50
years (31-69); 92F,174M; 93% IgG; 68% ≥ 2 bone lesions; 76%
stage III disease; median creatinine at autograft 83 µmol/L (46-
352); median B2M 2.3mg/L (0.1-16.4). 169 (60%) remained in or
attained complete remission after autograft; 75 partial remission;
13 non-responders and 9 (4%) died. The median OS and EFS of
these patients was 5.8 years and 2.3 years respectively. The EFS
curve shows a stable plateau after 7-8 years comprising 26 (10%)
such patients who remain event-free. This data is comparable to
the 515 patients presented by Tricot et al for tandem
transplantation as shown in the Table.
Variable RMH (n=266) Tricot et al (n=515)
Transplants Single All received single ,
77% received a
tandem autograft
Age ≥ 50 years 53% 58%
Stage III disease 76% 48%
Median OS 5.8 years (10days- 3.5 years
16years)
Median EFS 2.3 years (10 days- 1.4 years
16years)
7-year OS/EFS 42%/22% 31%/18%
Patients eventfree
at ≥5years
28% 24%
Based on previously described prognostic variables chosen by
recursive partitioning, there was a group of 85/272 (31%; B2M
missing in 4 ) patients with age