PTLD: Survival and analysis of prognostic factors in a cohort of 138 patients from a single institution.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e19048-e19048
Author(s):  
Rohit Bishnoi ◽  
Ravneet Bajwa ◽  
Aaron J Franke ◽  
Niraj Patel ◽  
William Paul Skelton ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Pediatric Population ◽  
Prognostic Score ◽  
Performance Status ◽  
Organ Transplant ◽  
Final Analysis ◽  
Treatment Modalities ◽  
Secondary Outcome ◽  
Line Treatment ◽  
Single Institution

e19048 Background: The outcome and prognostic factors of post-transplant lymphoproliferative disorder (PTLD) varies in currently reported literature. We present one of the largest single institution retrospective analysis from University of Florida. Methods: Patient population was identified from EMR and charts were reviewed to collect data. Primary outcome was Overall survival (OS) and secondary outcome was identification of prognostic factors. Results: We identified 138 patients with PTLD from Sept 1994 to Feb 2016 (liver 34%, Kidney 23%, heart 21%, lungs 12%, kidney-pancreas 2% and BMT 6%). After survival analysis, 131 patients were further followed for secondary outcomes. 36% (n = 47) were less than 18 years of age, 60% (n = 83) were males. The median age of PTLD diagnosis was 44 years and the median duration from transplant to PTLD was 4.4 years. Pathology was early lesion 6% (n = 8), polymorphic 17% (n = 23), Monomorphic 71% (n = 93), Hodgkin/like 4.5% (n = 6). Extra-nodal site involvement was 61% (n = 80), most common being GI tract. Ann-Arbor stage distribution was stage I/II 50% (n = 65), stage III/IV 46% (n = 60). Initial treatment was immunosuppression (IS) reduction alone in 24% (n = 31), Rituximab (R) 24% (n = 31), chemotherapy (+/- R) 46% (n = 60). Most common chemo regimen was CHOP (+/-R) 27% (N = 36). After first line, 48% patients had complete remission (CR), 18% partial remission (PR) and 15% progressive disease (PD). Second line treatment was required in 33% (n = 44) and 10% (n = 13) patients required 3rdline treatment. Final analysis showed 61% (n = 80) achieved CR, 17% (n = 22) had PD, 56% (n = 74) patients were alive and 49% (n = 64) are alive without PTLD. Median OS was 14.99 years. Multivariate analysis identified transplant age, organ transplant recipients, PTLD diagnosis age, performance status, IPI score, graft rejection, history of malignancy and recipient EBV status as prognostic factors (p < .05). Conclusions: This study from a leading regional transplant center shows notable OS which is likely from improved immunosuppressive regimens, treatment modalities and large pediatric population. We identified various prognostic factors affecting survival and propose validation to generate prognostic score.

Clinical prognostic factors associated with survival and a survival score for patients with brain metastases

2019 ◽  
Vol 15 (22) ◽  
pp. 2619-2634 ◽  
Author(s):  
Patricia Șuteu ◽  
Nicolae Todor ◽  
Radu-Mihai Ignat ◽  
Viorica Nagy
Keyword(s):  
Prognostic Factors ◽  
Brain Metastases ◽  
Prognostic Score ◽  
Performance Status ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Single Institution ◽  
Factors Associated ◽  
Cox Proportional Hazard ◽  
Status Number

Aim: To identify prognostic factors of survival in patients with brain metastases (BM) and to devise a prognostic score. Patients & methods: In this single-institution retrospective study, we analyzed potential clinical prognostic factors in 1363 patients with BM. Based on the Cox proportional hazard model, we devised a BM score with three classes (score <5, 5–6 and >6). Results: The 1-year overall survival (OS) was 26%. Independent prognostic factors of OS were: age, gender, Karnofski performance status, number of BM, control of primary, presence of extracerebral metastases and type of primary tumor. The 1-year OS was 56% for score <5; 21% for score 5–6 and 4% for score >6 (p < 0.01). Conclusion: The BM score we propose is effective in grouping patients according to their prognosis and can help decision making regarding treatment adjustments.

scholarly journals Modified FOLFIRINOX as a second-line therapy following gemcitabine plus nab-paclitaxel therapy in metastatic pancreatic cancer

2020 ◽  
Author(s):  
Masashi Sawada ◽  
Akiyoshi Kasuga ◽  
Takafumi Mie ◽  
Takaaki Furukawa ◽  
Takanobu Taniguchi ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Prognostic Factors ◽  
Prognostic Model ◽  
Prognostic Score ◽  
Objective Response ◽  
Metastatic Pancreatic Cancer ◽  
Line Treatment ◽  
Second Line ◽  
Second Line Therapy ◽  
Line Therapy

Abstract Background There is no established second-line treatment after failure of gemcitabine plus nab-paclitaxel (GnP) therapy for metastatic pancreatic cancer (MPC). This study aimed to evaluate the efficacy and tolerability of the modified FOLFIRINOX (mFFX) as a second-line therapy for MPC and investigate prognostic factors for survival. Methods From 2015–2019, we retrospectively reviewed the medical records of patients receiving mFFX for MPC after failure of GnP therapy. Patients were treated every 2 weeks with mFFX (intravenous oxaliplatin 85 mg/m 2 , intravenous irinotecan 150 mg/m 2 , and continuous infusion of 5-fluorouracil 2,400 mg/m 2 for 46 hours without bolus infusion) until disease progression, patient refusal, or unacceptable toxicity. Results In total, 104 patients received mFFX. The median overall survival (OS) was 7.0 months (95% confidence interval [CI]: 6.2-9.8) and the progression-free survival (PFS) 3.9 months (95% CI 2.8-5.0). The objective response rate was 10.6% and the disease control rate 56.7%. The median relative dose intensities of oxaliplatin, irinotecan, and infusional 5-FU were 80.0% (range 21.5-100%), 77.2% (range 38.1-100%), and 85.9% (range 36.9-100%), respectively. Grade 3-4 toxicities were reported in 57 patients (54.8%), including neutropenia, leukopenia, anemia, febrile neutropenia, and peripheral sensory neuropathy. Glasgow prognostic score and carcinoembryonic antigen level were independently associated with survival. Our prognostic model using these parameters could classify the patients into good (n = 38), intermediate (n = 47), and poor (n = 19) prognostic groups. The median OS and PFS time was 14.7 (95% CI 7.6-16.3) and 7.6 months (95% CI 4.1-10.5) for the good prognostic factors, 6.5 (95% CI 5.5-10.0) and 3.6 months (95% CI 2.7-4.8) for the intermediate prognostic factors and 5.0 (95% CI 2.9-6.6) and 1.7 months (95% CI 0.9-4.3) for the poor prognostic factors, respectively. Conclusions The mFFX showed to be a tolerable second-line treatment for MPC after GnP failure. Our prognostic model might be useful for deciding whether mFFX is indicated in this setting.

Prognostic factors and first-line treatment modalities in nonagenarian patients with lung cancer

2019 ◽  
Vol 10 (3) ◽  
pp. 439-441
Author(s):  
Cheng-Chieh Hsu ◽  
Ying-Tzu Huang ◽  
Yen-Han Tseng ◽  
Yung-Hung Luo ◽  
Yuh-Min Chen
Keyword(s):  
Lung Cancer ◽  
Prognostic Factors ◽  
Treatment Modalities ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

Is Longer MDS Duration Prior to Non-Intensive AML Treatment a Favorable Prognostic Factor? Results of the 00331 Multicenter Phase II Decitabine Trial

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2185-2185
Author(s):  
Michael Lubbert ◽  
Claudia Schmoor ◽  
Björn Rüter ◽  
Mathias Schmid ◽  
Ulrich Germing ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Research Funding ◽  
Disease Duration ◽  
Cox Regression ◽  
De Novo ◽  
Performance Status ◽  
Treatment Modalities ◽  
White Blood Count ◽  
Large Trial ◽  
Comorbidity Index

Abstract Abstract 2185 Background: Secondary (s)AML from MDS is more frequent in older AML patients, and associated with an overall worse outcome with standard chemotherapy than de novo AML, particularly after MDS of longer duration (1). The azanucleoside hypomethylating agents 5-azacytidine (Vidaza) and 5-aza-2′-deoxycytidine (Decitabine, DAC) are active in MDS and, as recently shown, also AML. Compared to other predictors of response to these drugs, MDS duration prior to treatment thus far has received only limited attention, with two recent publications reporting conflicting results (2, 3). To independently validate our finding that shorter duration of MDS prior to DAC treatment may be a novel predictor of poor outcome (2, 4), we now applied this parameter to a large trial of low-dose DAC in AML pts (aged >60 years and judged ineligible for standard induction chemotherapy), about half of them with sAML from MDS with variable disease duration. Patients and Methods: Comparisons of response rate (RR, i.e. CR or PR) and overall survival (OS) from start of treatment according to MDS duration (pre-specified categorization according to quartiles) were performed post-hoc in 109 patients (pts) with previously untreated sAML (median age 72 years) treated with DAC (given over 72 hours, every 6 weeks, for up to 4 courses, followed by “maintenance” with 3 daily 1-hour infusions of DAC 20 mg/m2 every 4–6-weeks). Median WBC prior to treatment was 5.200/μl, median serum LDH 279U/l, 31.2% of pts had adverse cytogenetics, 82.6% had a performance status > 1, and 80.7% had a comorbidity index (HCT-CI) >=1. Comparisons by logistic regression and Cox regression (univariate and multivariate, adjusted for other prognostic factors showing an effect in this population of sAML pts) were performed. Results: Of the 227 AML patients treated within the 00331 trial, 109 (48%) had prior MDS with known MDS duration, with a median duration of 8 (25% quartile 3, 75% quartile 25, range 1–101) mths. The overall RR in these pts was 26/109 (24%), the overall 1 yr OS rate was 31% (94 deaths). A comparison of RR according to MDS duration revealed a trend to an increase in RR with longer duration of MDS [<3: 4/25 (16%), 3–8: 5/29 (17%), 8–25: 7/27 (26%), >=25 mths: 10/28 (36%), test for heterogeneity p=0.29, test for trend p=0.06]. Similarly, when OS from start of DAC was analyzed according to this parameter, for pts with previous MDS of longer duration there was a trend to better outcome [<3: 1 yr OS rate 23%, 3–8: 28%, 8–25: 26%, >=25 mths: 46%, test for heterogeneity p=0.17, test for trend p=0.16]. When these analyses were adjusted for other prognostic factors showing an effect in this population of sAML pts (comorbidity index, sLDH with respect to RR, and performance status, comorbidity index, and white blood count with respect to OS), the results were similar (effect of MDS duration with respect to RR: test for heterogeneity p=0.35, test for trend p=0.06, and effect of MDS duration with respect to OS: test for heterogeneity p=0.04, test for trend p=0.11). Conclusion: In this large cohort of uniformly treated pts with sAML, MDS of longer duration appeared to be associated with a better outcome, even after adjusting for important other prognostic factors. These results are supported by a similar analysis of MDS pts randomized in the 06011 EORTC intergroup trial (which compares DAC to Best Supportive Care), where MDS patients with longer (>=3 mths) disease duration prior to treatment also had better outcome (4). They warrant application of this discriminator in the evaluation also of other non-intensive AML treatment modalities. References 1. Estey et al., Blood 90:2969-77, 1997 2. Wijermans et al., Ann. Hematol. 84 Suppl 1:9-14, 2005 3. Kantarjian et al., Cancer 109:265-73, 2007 4. Lübbert, Suciu et al., Abstract submitted, ASH 2010 Disclosures: Off Label Use: decitabine is FDA-approved for treatment of MDS and AML with up to 30% blasts. In the present study, patients with AML and higher blast percentage were treated. Platzbecker: Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Döhner: Pfizer: Research Funding.

Pretreatment prognostic factors associated with outcomes for first-line FCR-based treatments in previously untreated CLL.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6517-6517
Author(s):  
William G. Wierda ◽  
Susan Mary O'Brien ◽  
Stefan Faderl ◽  
Alessandra Ferrajoli ◽  
Jan Andreas Burger ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
High Risk ◽  
Performance Status ◽  
Absolute Lymphocyte Count ◽  
Patient Characteristics ◽  
Treatment Modalities ◽  
First Line ◽  
Liver Size ◽  
Improved Outcomes ◽  
New Treatment

6517 Background: First-line chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab (FCR) demonstrated improved outcomes, including survival, for fit patients (pts) with CLL. Modifications of this regimen, including intensified rituximab (FCR3), addition of mitoxantrone (FCMR) or addition of alemtuzumab fir high-risk CLL (CFAR), were evaluated but did not improve outcomes in historic comparisons. Methods: We correlated outcomes, including complete remission (CR), time-to-treatment failure (TTF) and overall survival (OS), with new and traditional pretreatment prognostic factors to identify high-risk pts. Results: All pts (N=473) had an NCI-WG indication for treatment and received a first-line FCR-based regimen on trial; the intended treatment was 6 courses. Patient characteristics correlated with outcomes are presented in the table. Factors not associated with outcomes included absolute lymphocyte count; platelet count; performance status; spleen size; liver size; and number of involved lymph node sites. Conclusions: We identified the following as high-risk pretreatment features for patients going on first-line FCR-based therapy: advanced age, presence of 17p del, high B2M (≥4mg/l), and unmutated IGHV gene. Pts with these features should be pursued with new treatment modalities and novel agents in order to improve outcomes. [Table: see text]

Identification of a microRNA (miRNA) based signature for survival in advanced non-small cell lung cancer (NSCLC) patients (pts) treated with cisplatin-vinorelbine: A ELCWP study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e18006-e18006
Author(s):  
Thierry Berghmans ◽  
Luc Willems ◽  
Marianne Paesmans ◽  
Lieveke Ameye ◽  
Jean-Jacques Lafitte ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Prognostic Score ◽  
Performance Status ◽  
Stage Iv ◽  
Progression Free Survival ◽  
Hazard Ratio ◽  
Cox's Regression ◽  
And Performance ◽  
A Prospective Study ◽  
Nsclc Patients

e18006 Background: Main prognostic factors for survival in NSCLC pts are stage and performance status (PS) while sex, histology and others are reported. However, these variables do not allow predicting individual prognosis, justifying further research. MiRNA are small non-coding RNAs regulating gene expression. As a secondary aim of a prospective study, we looked at the prognostic value of tumour miRNA on survival in NSCLC pts treated by cisplatin (60 mg/m2 D1) and vinorelbine (25 mg/m2, D1+8) 1st line chemotherapy. Methods: During the diagnostic bronchoscopy, a biopsy was lysed into Tripure Isolation Reagent (Roche Diagnostics) on ice, snap frozen and stored at -80°C. MiRNA expression was assessed using TaqMan Low Density Arrays (756 human miRNA panel, Applied Biosystems) and normalized using the delta delta CT method to RNU48 (SNORD48) CT value for every sample. Survival was measured from the registration date. Results: The main characteristics of 38 eligible pts were: median age 60 years, male 27 (71%), 80-100 Karnofsky PS in 26 (68%), adenocarcinoma 20 (53%), stage IV 30 (79%). At time of analysis, 25 pts were dead. After stepwise selection among 756 analysed miRNA, a combination of 4 miRNA including miR-200c, miR-424, miR-29c and miR-124 provided a prognostic signature for survival. Using a linear combination of the miRNA CT values with Cox's regression coefficients as weights, we constructed a prognostic score. With a cut-off of 52, the signature distinguished pts with good (n = 18) and poor (n = 20) prognosis with respective median survival of 47.3 months (95% CI 29.8-52.4) and 15.5 months (95% CI 9.1-22.8) (p <0.001; hazard ratio 21.1, 95% CI 4.7-94.9). The same signature discriminated pts with “good progression-free survival” (median 19.8 months; 95% CI 15.3-33.8) from the others (median 9.1 months; 95% CI 6.3-15.5) (p <0.001; hazard ratio 3.8, 95% CI 1.7-8.7). Conclusions: A 4 miRNA signature is associated with improved survival in patients with advanced stage NSCLC treated with 1st line cisplatin and vinorelbine. These results need confirmation in an independent cohort and the signature has to be compared to conventional prognostic factors.

scholarly journals Primary Gastric Lymphoma: Conservative Treatment Modality Is Not Inferior to Surgery for Early-Stage Disease

ISRN Oncology ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Fatih Selçukbiricik ◽  
Deniz Tural ◽  
Olgun Elicin ◽  
Selin Berk ◽  
Mustafa Özgüroğlu ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Conservative Treatment ◽  
Treatment Modality ◽  
Performance Status ◽  
Gastric Lymphoma ◽  
Poor Performance ◽  
Treatment Modalities ◽  
Poor Performance Status ◽  
Advanced Stage ◽  
Primary Gastric Lymphoma

Objectives. The aim of this study was to evaluate clinical characteristics, prognostic factors, survival rates, and treatment modalities in patients with primary gastric lymphoma (PGL). Methods. We retrospectively reviewed and analyzed data from patients treated for PGL in our clinic from 1998 through 2010. Staging was performed using the Lugano Staging System. Overall and disease-free survival (OS and DFS) were calculated from the date of diagnosis. Results. We identified 79 patients. Thirty-seven patients (47%) were male. The median age at presentation was 57 (18–85) years. The median follow-up time was 41 (9–52) months. Thirty patients (38%) underwent surgery, 74 (92%) received chemotherapy, and 18 (23%) received radiotherapy. The five-year OS and DFS rates were 91.2% and 83.9%, respectively, in patients with stage I/II or IIE disease and 70.6% and 65.5%, respectively, in patients with stage IV disease ( for both rates). Treatment modality (surgical or conservative) had no impact on OS or DFS in early stages. In a multivariate analysis, poor performance status, advanced stage, and high LDH levels were significant bad prognostic factors for DFS, while advanced stage, poor performance status, and age > 60 years were significant bad prognostic factors for OS. Conclusion. Surgery provides no advantage for survival over conservative treatment; thus, conservative treatment modalities should be preferred initially at early stages of PGL.

scholarly journals Early Deaths in Childhood Cancer in Romania—A Single Institution Study

Children ◽  
2021 ◽  
Vol 8 (9) ◽  
pp. 814
Author(s):  
Doina Paula Pruteanu ◽  
Elena Diana Olteanu ◽  
Rodica Cosnarovici ◽  
Emilia Mihut ◽  
Radu Ecea ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Treatment Time ◽  
Performance Status ◽  
Final Analysis ◽  
Late Presentation ◽  
Personal Identification ◽  
Single Institution ◽  
Significant Difference ◽  
After Cancer ◽  
Haematologic Malignancies

(1) Background: Survival in childhood cancer has improved significantly over the last decades. However, early deaths (EDs) represent an important number of preventable deaths. Our aim was to provide more insight intoEDs in developing countries. (2) Methods: We conducted a retrospective analysis of patients aged 0–18 years with childhood cancer diagnosed between 1996 and 2008 and admitted in the Institute of Oncology “Prof. Dr. Ion Chiricuta” Cluj-Napoca (IOCN), Romania. After exclusion of patients (pts) older than 18 years at diagnosis, pts with a missing personal identification number and pts with unconfirmed diagnosis of malignancy, we included 783 pts in the final analysis. We defined ED as survival of less than one month after cancer diagnosis. We divided pts in groups according to age, major tumour categories and treatment time periods. (3) Results: ED was registered in 20 pts (2.55%). A total of 16EDs were registered in haematologic malignancies and 4 in solid tumours. Statistical analysis was performed on pts diagnosed with haematological malignancies. A statistically significant higher proportion of patients with performance status (PS) 3 and 4 died within one month after diagnosis (24.1%) than patients admitted with PS 0–2 (1%)—p < 0.01. We found no statistically significant difference regarding ED when comparing male versus female (p = 0.85), age at diagnosis or between the threeperiods of diagnosis (p = 0.7). (4) Conclusions: PS at admission is an important risk factor associated with ED in pts with haematologic malignancies. ED in our institution reflects frequent late presentation for medical care, late diagnosis and referral to specialised centres.

Retrospective observational study of salvage line ramucirumab monotherapy (RAM) for patients (pts) with unresectable advanced gastric cancer (AGC) which was refractory to fluoropyrimidine and taxanes.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 129-129 ◽  
Author(s):  
Naoki Fukuda ◽  
Sadayuki Kawai ◽  
Katsuhiro Omae ◽  
Seiichiro Mitani ◽  
Takeru Wakatsuki ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Performance Status ◽  
Objective Response ◽  
Comparable Efficacy ◽  
Intestinal Bleeding ◽  
Line Treatment ◽  
Second Line ◽  
Her2 Positive ◽  
Neutrophil Lymphocyte Ratio ◽  
Line Setting

129 Background: RAM showed a survival benefit over best supportive care in second-line treatment after failure of fluoropyrimidine-containing chemotherapy for pts with advanced gastric or gastro-esophageal junction adenocarcinoma (AGC). In clinical practice, RAM is used for some pts who have disease refractory to fluoropyrimidine and taxanes in salvage line setting. Methods: We retrospectively evaluated efficacy and safety of RAM in salvage lines between June 2015 and April 2017 for AGC at four Japanese institutions. All pts received 2 or more prior regimens containing fluoropyrimidine and taxanes, but not ramucirumab. We also explored prognostic factors for progression free survival (PFS) and overall survival (OS). Results: Fifty-one pts were collected. Pts' characteristics were as follows; median age: 67 (range 39-84) years; ECOG performance status ≤ 1: 43 (84%) pts; HER2 positive: 17 (33%) pts; number of metastatic sites ≥ 2: 29 (57%); number of prior therapies 2/3/4/5: 7(14%)/25(49%)/12(24%)/7(14%) pts. Median PFS and OS were 1.9 (95% confidence interval [CI]: 1.6-2.2) and 5.1 (95% CI: 4.1-6.8) months, respectively. Twelve-week PFS rate was 25.5%. Objective response rate in 43 pts who had measurable disease was 2%. Disease control rate was 35%. Grade 3 adverse events (AEs) occurred in 7 (13%) pts such as anemia in 2 (4%), fatigue in 1 (2%), hypertension in 2 (4%), proteinuria in 2 (4%), intestinal bleeding in 1 (2%), and others in 2 (4%) pts. No grade 4 AEs and treatment related deaths were observed. Although multivariate analyses suggested that absence of primary tumor and neutrophil lymphocyte ratio < 2.5 at baseline were associated with better PFS, while statistically significant prognostic factors for OS were not identified in this study. Conclusions: Salvage line RAM showed acceptable toxicities and comparable efficacy with those reported in previous studies of second-line setting. It is suggested that RAM could be considered for salvage line treatment after fluoropyrimidine and taxanes containing regimens.

Prognostic Impact of Clinico-Pathological Parameters on the Outcome of Multiple Myeloma Patients: A Single-Center Analysis on 143 Consecutive Patients Treated with Standard Versus Intensive Chemotherapy.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5436-5436
Author(s):  
Truc Ngo ◽  
Martina Kleber ◽  
Barbara Deschler ◽  
Gabriele Ihorst ◽  
Monika Engelhardt
Keyword(s):  
Multiple Myeloma ◽  
Prognostic Factors ◽  
Statistical Significance ◽  
Performance Status ◽  
Stage Ii ◽  
Treatment Modalities ◽  
High Dose ◽  
Prognostic Impact ◽  
Group A ◽  
Group B

Abstract Multiple myeloma (MM) remains an incurable disease, with significant variation in the response and survival even with current treatment modalities, such as high-dose chemotherapy (CTx) and autologous stem cell transplantation (auto-SCT), novel drugs and intensive supportives. Hence, prognostic parameters that help to predict the benefit of different therapeutics are of utmost importance to be defined further. The objective of this analysis was to determine whether treatment selection and response are markedly influenced by specific clinico-pathological parameters and how these effect overall survival (OS). Of 143 consecutive MM patients (pts) receiving either standard therapy (Std-CTx, group A, n=79) or auto-SCT (group B, n=64) at our center between 1997–2003, gender, age, MM-type, -stage, number of CTx lines, LDH,β 2-MG and bone marrow (BM) infiltration were evaluated on response and survival in uni- and multivariate analyses and hazard ratios (HR) were determined. To further pay tribute to pts’ average age, as MM is primarily a disease of the elderly, special attention was paid to the influence of the performance status (Karnofsky Index=KI) and number of concurrent diagnoses (CD). Pts in groups A and B were comparable in terms of gender distribution, MM type, CD and LDH-level. However, group A as compared to B pts were older (65 vs. 56 yrs), had received more radiation (26 vs. 19%) and showed higher β2-MG (5 vs. 2.3g/L; respectively). Moreover, pts in group B as compared to A had more advanced disease (Durie and Salmon [D&S] stage II/III: 92 vs. 65%), a higher BM-infiltration (40 vs. 30%), and were treated later in their disease course. In group A pts, HR were increased for β2-MG>3, D&S stage II/III, stage B disease, CD>1, LDH>200U/L and age >60y, and HR decreased for females and KI>80%, reaching significance for β2-MG, D&S stage II/III, stage B disease, CD and KI. Although these HR were also observed for group B pts, none of these prognostic factors reached statistical significance. Multivariate analysis on all pts identified β2-MG >3mg/L and age >60y as independent prognostic factors, with HRs of 3.6 (95% CI 1.6–8.1) and 2.1 (CI 0.9–5.0), respectively. Of note, current CR/PR rates for group A and B pts are 4 vs. 20%, and at last follow-up (6/2006) median OS from treatment initiation is 49.5% vs. 61.4%, respectively. Our data show that an elevated β2-MG, D&S stage II/III, stage B disease, more than 1 CD and reduced performance status before therapy, negatively influence response and OS in Std-group pts, whereas these do not significantly impact HR in auto-SCT pts. We conclude that MM pts benefit from auto-SCT independently of prognostic factors which, however, do impact outcome with Std-CTx alone. Since randomized trials have repetitively shown response and survival with auto-SCT to be superior to Std-CTx, we propose that pts with the above prognostic factors should be carefully evaluated for intensive therapies, as this analysis accentuates that auto-SCT is the treatment of choice for eligible MM pts.

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