182: Conventional Chemotherapy with Interferon Versus Conventional Chemotherapy followed by High Dose Chemotherapy and Autologous Stem Cell Transplantation in Untreated Patients with Advanced Follicular Lymphoma. A Meta-Analysis of Randomized Clinical Trials

Abstract Neuronal cell adhesion molecule (NCAM, CD56) is expressed by approximately 75% of multiple myeloma (MM) clones. The lack of CD56 expression on MM cells is described to be associated with a higher frequency of extramedullary involvement (Pellat-Deceunynck et al. 1998) and a lower overall survival in patients treated by conventional chemotherapy (Sahara et al. 2002). We analyzed the CD56 expression of myeloma cells by flowcytometry in 52 newly diagnosed patients to determine its prognostic and clinical relevance. Seventeen of 52 patients were NCAM-negative and 35 patients NCAM positive. The CD56 expression did not correlate with elevated beta2-microglobulin levels or deletions of chromosome 13q14 as investigated by interphase FISH. All patients were scheduled for treatment according to the GMMG-HD3 protocol and received 3 cycles of VAD or TAD induction chemotherapy, followed by CAD chemotherapy, stem cell collection and high dose chemotherapy with melphalan and autologous stem cell transplantation (ASCT). We analyzed the response rate (EBMT/IBMTR criteria) 3 months after the first ASCT and the event free survival (EFS) (median 479 days, range 29–911 days). Three months after the first ASCT, 6/17 of the CD56 negative patients were in CR, 7/17 in PR, 1/17 in MR and 3/17 had PD. Of the CD56 positive patients evaluated for clinical outcome 5/35 showed CR, 20/35 a PR and 10/35 a PD. In an intention-to-treat analysis, EFS showed no significant difference between these two groups. With only 13 events out of 52 cases, a longer follow up in terms of EFS and OS is required. We conclude that in patients treated by high-dose melphalan and autologous stem cell transplantation, the lack of CD56 did not correlate with a poor response rate 3 month after transplantation. Our preliminary results indicate that high-dose therapy followed by ABSCT is able to overcome the poor prognosis of CD56 negative patients treated with conventional chemotherapy.

Download Full-text

Multiple myeloma: Autologous stem cell transplantation versus conventional chemotherapy—A retrospective age and stage matched analysis

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.7041 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 7041-7041 ◽

Cited By ~ 2

Author(s):

A. Gupta ◽

L. Kumar ◽

D. Dabkara ◽

D. Gupta ◽

O. Sharma ◽

...

Keyword(s):

Multiple Myeloma ◽

Overall Survival ◽

Stem Cell ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Autologous Stem Cell Transplantation ◽

Group Versus ◽

High Dose Chemotherapy ◽

High Dose ◽

Conventional Chemotherapy

7041 Background: We retrospectively analyzed results of MM patients who underwent high-dose chemotherapy and stem cell transplantation (ASCT). In age and stage matched analysis, we compared with those patients who received conventional chemotherapy. Methods: Between January 1995 and June 2007, 95 patients underwent ASCT (Tx Group). 149 age and stage matched patients received conventional chemotherapy (CC Group). High-dose melphalan (200 mg/m2) was used for conditioning in Tx group. Baseline characteristics were comparable in both groups: median age was 50 years (range, 26 to 68 years) in Tx group versus 52 years (range 24 to 68 years) in CC group, p < 0.05; M:F = Tx Group -68:27 versus CC Group 98:51, p = 0.34; stage 3A/3B = 76.8%/23.2% in Tx Group versus 62.4%/37.6%, p = 0.02; mean Hb (Gm/dl) 9.1(range, 3.3–14.3) versus 8.6 (3.3–14.8), p = 0.21; median serum albumin (Gm/dl) 3.5 (range, 1.8–5.2) versus 3.4 (1.6–6.2), p = 0.7, respectively in two groups. Results: Following treatment, the response rates (CR + VGPR + PR = 81%) were significantly higher in Tx group compared to CC group (55%), p = 0.001. CR rate was higher in Tx group, 34.7% versus 12.8%, p < 0.001. The median overall survival was significantly higher in Tx group (75 months, 95%CI [72–106 months]) versus (24 months, 95%CI [19–36months]), p = 0.001. The median progression free survival was 30 months in Tx group (95%CI [21–48 months]) compared to 6 months in CC group (95% CI 3–9 months), p < 0.0001. Estimated overall survival at 5 years in Tx group is 66.6% (95% CI [54.8%-75.9%]) compared to 20.7% (95% CI [13.5%-29%]) in CC group. Conclusions: High-dose chemotherapy followed by autologous stem cell transplantation results in higher overall and complete response rates in multiple myeloma patients. This is associated with improved progression free and overall survival. Low-dose maintenance therapy to sustain the survival benefit of transplant would be possible areas of research in future studies. No significant financial relationships to disclose.

Download Full-text