An elective single autograft with high-dose melphalan: single-center study of 451 patients

In all, 451 myeloma patients, 51% previously untreated, underwent elective single autotransplantation after 200 mg/m2 melphalan between 1985 and 2001 at the Royal Marsden Hospital. The therapy sequence was: Induction (vincristine, doxorubicin, methylprednisolone±cyclophosphamide), marrow or filgrastim-mobilized blood stem cell harvest, autograft, and interferon-α2b maintenance. A total of 27 (6%) died of transplant-related toxicity, all within 3 months. Complete or near-complete remission was seen in 59% with an overall response rate of 91%. Subsequent disease progression was seen in 285, and 17 died of unrelated causes. In all, 206 patients were alive at the last follow-up, 6 months to 17.7 years post-transplant (median 65 months); 122 without disease progression at 6 months to 17.7 years (median 58 months). The median overall (OS) and event-free (EFS) survivals were 5.9 and 2.4 years, with 10-year OS and EFS probabilities of 31.4 and 16.5%, respectively. In Cox analysis, it was seen that significantly longer OS occurred for patients who had β-2-microglobulin <3.5 mg/l (P<0.0001), age <60 years (P=0.001) and albumin ⩾35 g/l (P=0.009). EFS was also longer if β-2-microglobulin was <3.5 mg/l (P=0.0056) and patients were <60 years of age (P=0.033). We conclude that with a single planned autograft, patients with myeloma have an excellent outcome.