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Melphalan 140 mg/m 2 or 200 mg/m 2 for 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.
- Source :
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Haematologica [Haematologica] 2018 Mar; Vol. 103 (3), pp. 514-521. Date of Electronic Publication: 2017 Dec 07. - Publication Year :
- 2018
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Abstract
- Melphalan at a dose of 200 mg/m <superscript>2</superscript> is standard conditioning prior to autologous hematopoietic stem cell transplantation for multiple myeloma, but a dose of 140 mg/m <superscript>2</superscript> is often used in clinical practice in patients perceived to be at risk of excess toxicity. To determine whether melphalan 200 mg/m <superscript>2</superscript> and melphalan 140 mg/m <superscript>2</superscript> 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/m <superscript>2</superscript> (n=245) and melphalan 200 mg/m <superscript>2</superscript> (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/m <superscript>2</superscript> in patients transplanted in less than partial response (adjusted hazard ratios for melphalan 200 mg/m <superscript>2</superscript> versus melphalan 140 mg/m <superscript>2</superscript> : 0.5, 0.54, and 0.56). In contrast, transplantation in very good partial or complete response significantly favored melphalan 140 mg/m <superscript>2</superscript> 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/m <superscript>2</superscript> and melphalan 140 mg/m <superscript>2</superscript> 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/m <superscript>2</superscript> or melphalan 140 mg/m <superscript>2</superscript> for key transplant outcomes (NCT01362972).<br /> (Copyright© 2018 Ferrata Storti Foundation.)
- Subjects :
- Adult
Aged
Dose-Response Relationship, Drug
Female
Hematopoietic Stem Cell Transplantation methods
Humans
Male
Melphalan therapeutic use
Middle Aged
Recurrence
Survival Analysis
Transplantation Conditioning methods
Transplantation, Autologous methods
Treatment Outcome
Melphalan administration & dosage
Multiple Myeloma therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1592-8721
- Volume :
- 103
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Haematologica
- Publication Type :
- Academic Journal
- Accession number :
- 29217776
- Full Text :
- https://doi.org/10.3324/haematol.2017.181339