Autologous Stem Cell Transplantation Is an Effective Salvage Therapy for Primary Refractory Multiple Myeloma

Abstract

High-dose therapy and autologous stem cell transplantation (ASCT) have proven efficacy in patients with multiple myeloma responding well to induction therapy. For those who fail to achieve a stable partial response (PR), the effect of ASCT is unclear. We report on 126 patients identified from a national database, who underwent ASCT having achieved <PR after induction with modern induction regimens. The overall response rate was 86% (24% complete response). Patients with progressive disease at the time of transplantation had poorer outcomes than those with minimally responsive or stable disease, but clinical benefit was seen in all groups. Day 100 and 1-year nonrelapse mortalities were 2% and 4%, respectively. The 5-year relapse rate and progression-free survival were 84% and 14% (median, 18 months), respectively. The 5-year overall survival was 42% (median, 51 months). Our findings support the use of ASCT in myeloma patients responding suboptimally to modern induction therapies. Patients should not be excluded on the basis of refractoriness to induction, as ASCT is effective in this group conventionally considered to have a poor outcome. Comprehensive multivariate analysis identified no disparate subgroups, meaning ASCT is a reasonable strategy for all fit primary refractory patients.

Keywords: Autologous stem cell transplantation; Myeloma; Refractory disease.