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Autografting

An elective single autograft with high-dose melphalan: single-center study of 451 patients

Bone Marrow Transplantation volume 36, pages 19–24 (2005)Cite this article

Summary:

In all, 451 myeloma patients, 51% previously untreated, underwent elective single autotransplantation after 200 mg/m2 melphalan between 1985 and 2001 at the Royal Marsden Hospital. The therapy sequence was: Induction (vincristine, doxorubicin, methylprednisolone±cyclophosphamide), marrow or filgrastim-mobilized blood stem cell harvest, autograft, and interferon-α2b maintenance. A total of 27 (6%) died of transplant-related toxicity, all within 3 months. Complete or near-complete remission was seen in 59% with an overall response rate of 91%. Subsequent disease progression was seen in 285, and 17 died of unrelated causes. In all, 206 patients were alive at the last follow-up, 6 months to 17.7 years post-transplant (median 65 months); 122 without disease progression at 6 months to 17.7 years (median 58 months). The median overall (OS) and event-free (EFS) survivals were 5.9 and 2.4 years, with 10-year OS and EFS probabilities of 31.4 and 16.5%, respectively. In Cox analysis, it was seen that significantly longer OS occurred for patients who had β-2-microglobulin <3.5 mg/l (P<0.0001), age <60 years (P=0.001) and albumin ⩾35 g/l (P=0.009). EFS was also longer if β-2-microglobulin was <3.5 mg/l (P=0.0056) and patients were <60 years of age (P=0.033). We conclude that with a single planned autograft, patients with myeloma have an excellent outcome.

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Acknowledgements

This study was supported by the Bud Flanagan Leukaemia Fund, the David Adams Leukaemia Fund, the Johnsten Britten Myeloma Fund, the Cancer Research Campaign, and the Institute of Cancer Research. We acknowledge the help of Ms Gabriella Powles in assembling the patient case notes.

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Author notes

  1. J Mehta & S Singhal

    Present address: Division of Hematology/Oncology, The Feinberg School of Medicine, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, USA

Authors and Affiliations

  1. Leukaemia and Myeloma Units, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK

    B Sirohi, R Powles, J Mehta, C Rudin, S Kulkarni, C Horton, R Saso, S Singhal & J Treleaven

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  1. B Sirohi
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  2. R Powles
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Correspondence to B Sirohi.

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Sirohi, B., Powles, R., Mehta, J. et al. An elective single autograft with high-dose melphalan: single-center study of 451 patients. Bone Marrow Transplant 36, 19–24 (2005). https://doi.org/10.1038/sj.bmt.1705000

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