Early Second Transplant For Multiple Myeloma May Improve Outcome

Analysis of the data on an intent-to-treat basis immediately "identified a problem," the authors report in the May 1st issue of the Journal of Clinical Oncology. Fewer than 60% of patients in the planned multiple transplant group actually received more than one transplant, whereas 9% of patients in the control group did undergo a second transplant.

Median survival after transplantation was 60 months in the multiple transplant group and 51 months in the control group, the researchers found.

They also found, however, that the "planned and unplanned curves cross at...70 months."  Up to that point, the investigators said, the overall survival hazard ratio in the planned multiple transplant group was 0.89; but after 70 months, the hazard ratio in this group rose to 3.01.

Patients who received their second transplant before relapse had an increased probability of transplant-related mortality, especially if the second transplant was done more than a year after the first.  However, the risk of relapse was lower when the transplantation was performed earlier.

"A second transplantation after relapse does not seem to prolong survival, though a second transplantation before relapse is associated with a higher probability of mortality," the researchers write.

"To improve survival of tandem autologous transplantation in multiple myeloma, the second transplantation should preferably be performed before relapse and within 6 to 12 months of the first transplantation," the authors conclude.

SOURCE:

• Journal of Clinical Oncology 2004;22:1674-1681