Haematologica 2003 - Supplements

Roundtable 3: ASCT IN SPECIAL SITUATIONS
P10.3.1
AUTOLOGOUS STEM CELL TRANSPLANT IN SPECIAL
SITUATIONS: REFRACTORY /RELAPSED DISEASE
Ray Powles, Bhawna Sirohi , Clive Horton
An alternative to tandem autotransplantation is wait until relapse
before giving the second transplant. We have previously shown
that results with a single autotransplant conditioned with
HDM200 are comparable to those with tandem transplants (Sirohi
et al, Proc Am Soc Clin Oncol 2002; 21:269a). We have analysed
a group of 96 myeloma patients (34-77 years, median 55)
relapsing after one autograft who underwent a second autograft
with HDM200. The median interval between the two autografts
was 3.2 years (range, 6 weeks to 11.8 years ). At relapse, of these
96 patients 87 received reinduction with infusional
chemotherapy(n=86)/other (n=1); 9 received HDM200 with the
cells harvested while in first CR. At the time of salvage autograft
6 patients were in CR, 43 partial remission (PR) and 47 were
non-responders (NR) or had progressive disease (PD). 32%
patients attained or continued in CR after salvage autograft and
the overall response rate was 76%. 9 patients died of treatmentrealted
mortality and 6 died of PD. 56 patients experienced
disease progression at a median of 10.5 months. Overall, 33
patients are alive at the last follow-up 2 weeks to 10.9 years post
salvage autotransplant. The actuarial 3-year probabilities of
relapse, disease-free survival and overall survival from salvage
transplant were 84%, 13%, and 35% respectively. The variables
anaylsed for prognostic significance in multivariate analysis at
the time of salvage autotransplant were-age, sex, immunologic
subtype of myeloma, interval between two autografts, disease
stage at salvage autograft, calcium, creatinine, beta-2-
microglobulin( B2M), albumin, performance status and source of
cells. The results of this analysis are shown in the Table.
Event Favorable co-variate RR P
OS
Interval between two 0.25 0.0004
EFS
Relapse
Probability of
CR2
autografts > 2years
Interval between two
autografts > 2years
B2M