RELAPSE OF MULTIPLE-MYELOMA AFTER AUTOLOGOUS TRANSPLANTATION - SURVIVAL AFTER SALVAGE THERAPY

Owing to lack of progress with standard chemotherapy and the presence of a dose response effect for alkylating agents, autotransplantation is performed with increasing frequency for multiple myeloma (MM), However, sustained relapse-free survival is still infrequent, We studied 94 patients who had relapsed following autotransplantation, in order to evaluate the efficacy of further therapy, Post-transplant salvage treatment consisted of either standard dose therapy (53) or transplantation with an intensive preparative regimen (with autograft support in 31 and allogeneic transplantation in 10), Complete remission (CR) rate, event-free and overall survival were assessed and prognostic variables identified in a multivariate regression analysis, With a median follow-up of 11 months, the projected overall survival at 18 months for all patients is 59%, A multivariate analysis identified pre-salvage beta-2-microglobulin (B2M) less than or equal to 2.5 mg/l (P = 0.0002) and late relapse after the preceding transplant (>12 months; (P = 0.02) as independent significant favorable variables for overall survival. By combining pre-salvage B2M and the time to relapse, 2 risk groups of patients could be indentified with significantly different overall survival: those with at least one favorable variable had a projected survival at 18 months of 79%, compared to 38% for patients with no favorable variable, Transplantation performed as primary salvage therapy was associated with a significantly prolonged survival (P = 0.009), although this may be more a reflection of the way salvage therapy was selected. After inclusion in the transplant group of 15 patients who initially received salvage chemotherapy with subsequent transplantation, the survival advantage for the transplant group was no longer apparent (P = 0.2), Our results support the notion that MM patients relapsing after autotransplants generally continue to benefit from further therapy, ie, there is 'life after relapse from transplant', Further transplantation in patients with early relapse and only one prior transplant is feasible and results in prolonged overall survival in those patients presenting with a low B2M at the time of relapse.