High-dose chemotherapy with autologous stem cell transplantation for multiple myeloma: what predicts the outcome? Experience from a developing country

Abstract

We analyzed the results of 108 patients (78 males and 30 females) with multiple myeloma who underwent autologous stem cell transplantation (ASCT). The median age of patients was 52 years (range, 26-68 years). High-dose melphalan (200mg/m²) was used for conditioning. In all, 66 (61%) patients had evidence of chemo-sensitive disease before transplant. After ASCT 79.6% of patients responded: complete response 36%, very good partial response 29.6%, and partial response 13.9%. Complete response rate was higher for patients with chemo-sensitive disease; 33 of 66 (50.0%) patients achieved complete response compared with 7 of 42 (14.3%) patients with progressive disease, P<0.01. Response rates to ASCT were significantly low for patients with Hb ≤8.5g/dl, serum albumin ≤3.3g/dl, β-2 microglobulin >5.5mg/l, International Staging System stage III at diagnosis and >12 months interval from diagnosis to transplant. Grade III-IV mucositis was the major regimen-related toxicity. At a median follow-up of 70 months, the median overall survival and event free survival (EFS) were 71 and 42 months, respectively. Estimated overall survival and EFS at 60 months were 54.4±0.05% (s.e.) and 49.3±0.05% (s.e.), respectively. Survival was significantly better for patients with pre-transplant chemo-sensitive disease and for those who achieved complete response following transplant.