Tandem Autologous Transplants More Effective than Single Autologous Transplants

Tandem Autologous Transplants More Effective than Single Autologous Transplants for Patients with Multiple Myeloma

The standard treatment for patients with stage II and III newly diagnosed multiple myeloma is chemotherapy induction followed by a single high-dose chemotherapy treatment and autologous stem cell support. Even with this treatment, the complete response rate is approximately 30-35%. Several groups of physicians have evaluated the potential benefit of using 2 cycles of high-dose chemotherapy with autologous stem cell support for patients with multiple myeloma.

Physicians in France performed a clinical trial in which 402 newly diagnosed patients with multiple myeloma were treated with either one cycle of melphalan chemotherapy and total body irradiation or one cycle of high-dose melphalan and one cycle of melphalan and total body irradiation supported by autologous peripheral blood stem cells.

Overall, 85% of patients received the first cycle of high-dose chemotherapy and 78% received both cycles of treatment. The complete remission rate was 39% with 1 cycle of treatment and 49% after 2 cycles of treatment. However, there were no differences in survival between the 2 groups of patients. Good risk patients as evidenced by a low beta 2 microglobulin experienced a 3-year survival of 84% if treated with 2 cycles of treatment compared to 69% for those receiving only 1 cycle of high-dose chemotherapy treatment.

While this study needs additional follow-up for definitive analysis, it suggests that 2 cycles of treatment is of significant benefit to patients who already have a reasonably good outcome, but may not improve the outcomes for patients with more aggressive disease. Different high-dose treatment regimens are currently being evaluated and may be more effective than the ones chosen for this study. (

Blood, Vol 94, No 10, Suppl 1, Abstract 3152, pp 714a, 1999)

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