Melphalan 140mg/m2 or 200mg/m2 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
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Melphalan 140mg/m2 or 200mg/m2 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. / Auner, Holger W; Iacobelli, Simona; Sbianchi, Giulia; Knol-Bout, Cora; Blaise, Didier; Russell, Nigel H; Apperley, Jane F; Pohlreich, David; Browne, Paul; Kobbe, Guido; Isaksson, Cecilia; Lenhoff, Stig; Scheid, Christoph; 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.
In: HAEMATOLOGICA, Vol. 103, No. 3, 03.2018, p. 514-521.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Melphalan 140mg/m2 or 200mg/m2 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
AU - Auner, Holger W
AU - Iacobelli, Simona
AU - Sbianchi, Giulia
AU - Knol-Bout, Cora
AU - Blaise, Didier
AU - Russell, Nigel H
AU - Apperley, Jane F
AU - Pohlreich, David
AU - Browne, Paul
AU - Kobbe, Guido
AU - Isaksson, Cecilia
AU - Lenhoff, Stig
AU - Scheid, Christoph
AU - Touzeau, Cyrille
AU - Jantunen, Esa
AU - Anagnostopoulos, Achilles
AU - Yakoub-Agha, Ibrahim
AU - Tanase, Alina
AU - Schaap, Nicolaas
AU - Wiktor-Jedrzejczak, Wieslaw
AU - Krejci, Marta
AU - Schönland, Stefan O
AU - Morris, Curly
AU - Garderet, Laurent
AU - Kröger, Nicolaus
N1 - Copyright © 2017, Ferrata Storti Foundation.
PY - 2018/3
Y1 - 2018/3
N2 - 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/m2versus 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).
AB - 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/m2versus 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).
KW - Journal Article
U2 - 10.3324/haematol.2017.181339
DO - 10.3324/haematol.2017.181339
M3 - SCORING: Journal article
C2 - 29217776
VL - 103
SP - 514
EP - 521
JO - HAEMATOLOGICA
JF - HAEMATOLOGICA
SN - 0390-6078
IS - 3
ER -
