Melphalan 140 mg/m2or 200 mg/m2for autologous transplantation in myeloma: Results from the collaboration to collect autologous transplant outcomes in Lymphoma and Myeloma (CALM) study. A report by the EBMT chronic malignancies working party
Item Type:Journal Article
Citation:Auner, H.W., Iacobelli, S., Sbianchi, G., Knol-Bout, C., Blaise, D., Russell, N.H., Apperley, J.F., Pohlreich, D., Browne, P.V., Kobbe, G., Isaksson, C., Lenhoff, S., Scheid, C., Touzeau, C., Jantunen, E., Anagnostopoulos, A., Yakoub-Agha, I., Tanase, A., Schaap, N., Wiktor-Jedrzejczak, W., Krejci, M., Schönland, S.O., Morris, C., Garderet, L. & Kröger, N. Melphalan 140 mg/m2or 200 mg/m2for autologous transplantation in myeloma: Results from the collaboration to collect autologous transplant outcomes in Lymphoma and Myeloma (CALM) study. A report by the EBMT chronic malignancies working party, Haematologica, 103, 3, 2018, 514-521
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Melphalan at a dose of 200 mg/m2 is standard conditioning prior to autologous hematopoietic stem cell transplantation for multiple myeloma, but a dose of 140 mg/m2 is often used in clinical practice in patients perceived to be at risk of excess toxicity. To determine whether melphalan 200 mg/m2 and melphalan 140 mg/m2 are equally effective and tolerable in clinically relevant patient subgroups we analyzed 1964 first single autologous transplantation episodes using a series of Cox proportional-hazards models. Overall survival, progression-free survival, cumulative incidence of relapse, non-relapse mortality, hematopoietic recovery and second primary malignancy rates were not significantly different between the melphalan 140 mg/m2 (n=245) and melphalan 200 mg/m2 (n=1719) groups. Multivariable subgroup analysis showed that disease status at transplantation interacted with overall survival, progression-free survival, and cumulative incidence of relapse, with a significant advantage associated with melphalan 200 mg/m2 in patients transplanted in less than partial response (adjusted hazard ratios for melphalan 200 mg/m2 versus melphalan 140 mg/m2 : 0.5, 0.54, and 0.56). In contrast, transplantation in very good partial or complete response significantly favored melphalan 140 mg/m2 for overall survival (adjusted hazard ratio: 2.02). Age, renal function, prior proteasome inhibitor treatment, gender, or Karnofsky score did not interact with overall/progression-free survival or relapse rate in the melphalan dose groups. There were no significant survival or relapse rate differences between melphalan 200 mg/m2 and melphalan 140 mg/m2 patients with high-risk or standard-risk chromosomal abnormalities. In conclusion, remission status at the time of transplantation may favor the use of melphalan 200 mg/m2 or melphalan 140 mg/m2 for key transplant outcomes (NCT01362972).
Author: Browne, Paul; Auner, Holger W.; Iacobelli, Simona; Sbianchi, Giulia; Knol-Bout, Cora; Blaise, Didier; Russell, Nigel H.; Apperley, Jane F.; Pohlreich, David; Kobbe, Guido; Isaksson, Cecilia; Lenhoff, Stig; Scheid, Christof; Touzeau, Cyrille; Jantunen, Esa; Anagnostopoulos, Achilles; Yakoub-Agha, Ibrahim; Tanase, Alina; Schaap, Nicolaas; Wiktor-Jedrzejczak, Wieslaw; Krejci, Marta; Schönland, Stefan O.; Morris, Curly; Garderet, Laurent; Kröger, Nicolaus
Type of material:Journal Article
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