Long-term outcome results of the first tandem autotransplant trial for multiple myeloma Bart Barlogie, Guido J. Tricot, Frits van Rhee, Edguardo Angtuaco, Ron Walker, Joshua Epstein, John D. Shaughnessy, Sundar Jagannath, Vanessa Bolejack,Jennifer Gurley BJH October Vol. 135
Background Multiple myeloma : a malignant proliferation of plasma cells derived from a single clone. Theraphy : MP(standard) VAD VAD PBSCT PBSCT
Patients and methods 231 newly diagnosed patients Induction ->first transplant->second transplant->maintanance Median follow-up of 12 years P-value<0.05 : significant
Results
Fig 1. Time to completion of treatment steps
Fig 2. Clinical outcome of patients
Fig 3. Kaplan–Meier plot of postrelapse survival
Fig 4. Kaplan–Meier survival plots from study enrolment according to the presence of certain cytogenetic abnormalities (CAs)
Fig 5. Kaplan–Meier plots of survival of patients treated with Total Therapy 1 (TT1) in the context of IFM94 trial results Discussion
Durie-Salmon staging system stage 1: all of Hb > 10g/dL normal calcium Skeletal survey: normal or single plasmacytoma or osteoporosis Serum paraprotein level < 5 g/dL if IgG, < 3 g/dL if IgA Urinary light chain excretion < 4 g/24h stage 2: fulfilling the criteria of neither 1 nor 3 stage 3: one or more of Hb < 8.5g/dL high calcium > 12mg/dL Skeletal survey: 3 or more lytic bone lesions Serum paraprotein >7g/dL if IgG, > 5 g/dL if IgA Urinary light chain excretion > 12g/24h Stages 1, 2 and 3 of the Durie-Salmon staging system can be divided into A or B depending on serum creatinine: A: serum creatinine < 2mg/dL (< 177 umol/L) B: serum creatinine > 2mg/dL (> 177 umol/L)
International Staging System The International Staging System (ISS) for myeloma was published by the International Myeloma Working Group in 2003 [2]: [2] Stage I: β2-microglobulin (β2M) = 3.5 g/dL β2-microglobulin albuminβ2-microglobulin albumin Stage II: β2M < 3.5 and albumin < 3.5; or β2M between 3.5 and 5.5 Stage III: β2M > 5.5