1. 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 2006 - Vol. 135

2. Background   Multiple myeloma : a malignant proliferation of plasma cells derived from a single clone.  Theraphy : MP(standard) VAD VAD PBSCT PBSCT

3. Patients and methods  231 newly diagnosed patients  Induction ->first transplant->second transplant->maintanance  Median follow-up of 12 years  P-value<0.05 : significant

4. Results

7. Fig 1. Time to completion of treatment steps

8. Fig 2. Clinical outcome of patients

9. Fig 3. Kaplan–Meier plot of postrelapse survival

12. Fig 4. Kaplan–Meier survival plots from study enrolment according to the presence of certain cytogenetic abnormalities (CAs)

13. Fig 5. Kaplan–Meier plots of survival of patients treated with Total Therapy 1 (TT1) in the context of IFM94 trial results Discussion

14. 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)

15. 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