MULTIPLE MYELOMA Stem cell transplantation in multiple myeloma

High-dose treatment (HDT) with autologous stem cell transplantation (ASCT) has been shown to increase survival and time to progression in multiple myeloma (IMM) compared with conventional chemotherapy. In the French IFM90-study [1], 200 patients were randomised to receive prolonged standard treatment with i.v. combination chemotherapy, or a short phase by induction treatment with the same regimen, followed by high-dose melphalan / TBI and autologous bone marrow transplantation (ABMT). Median survival was signficantly better in the ABMT-arm, /60 months, vs. 37 months in the chemotherapy arm, and also event-free survival was superior, 27 months vs. 18 months. These differences are sustained in a long term follow-up, where actuarial survival at 7 years was 43% and 25%, and EFS was 16% and 8% in the ABMTand chemotherapy arms, respectively. However, these latter differences were only observed in patients under the age of 60 at the time of inclusion in the study, while there was no benefit in older patients [1a]. Similar results have been demonstrated in a more recently published study from the British MRC [2]: 401 patients were randomized to receive either standard chemotherapy (cVAMP) or cVAMP followed by high-dose melphalan and autologous SCT. Median overall survival (OS) was signficantly superior in the ASCT-arm / 51 months */ compared with 42 months in the cVAMP-group. The difference was most pronounced in patients with a high beta-2-microglobulin (b-2-m) value at diagnosis, i.e. with a poorer prognosis.