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 - Université de Lille Accéder directement au contenu
Article Dans Une Revue Haematologica Année : 2018

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

W Auner Holger
  • Fonction : Auteur
Simona Iacobelli
  • Fonction : Auteur
Giulia Sbianchi
  • Fonction : Auteur
Cora Knol-Bout
  • Fonction : Auteur
Didier Blaise
H Russell Nigel
  • Fonction : Auteur
F Apperley Jane
  • Fonction : Auteur
David Pohlreich
  • Fonction : Auteur
V Browne Paul
  • Fonction : Auteur
Guido Kobbe
  • Fonction : Auteur
Cecilia Isaksson
  • Fonction : Auteur
Stig Lenhoff
  • Fonction : Auteur
Christof Scheid
  • Fonction : Auteur
Cyrille Touzeau
  • Fonction : Auteur
Esa Jantunen
  • Fonction : Auteur
Achilles Anagnostopoulos
  • Fonction : Auteur
Alina Tanase
  • Fonction : Auteur
Nicolaas Schaap
  • Fonction : Auteur
Wieslaw Wiktor-Jedrzejczak
  • Fonction : Auteur
Marta Krejci
  • Fonction : Auteur
Stefan Schonland
  • Fonction : Auteur
Curly Morris
  • Fonction : Auteur
Laurent Garderet
  • Fonction : Auteur
Nicolaus Kroger
  • Fonction : Auteur

Résumé

Melphalan at a dose of 200 mg/m(2) is standard conditioning prior to autologous hematopoietic stem cell transplantation for multiple myeloma, but a dose of 140 mg/m(2) is often used in clinical practice in patients perceived to be at risk of excess toxicity. To determine whether melphalan 200 mg/m(2) and melphalan 140 mg/m(2) 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(2) (n=245) and melphalan 200 mg/m(2) (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(2) in patients transplanted in less than partial response (adjusted hazard ratios for melphalan 200 mg/m(2)versus melphalan 140 mg/m(2): 0.5, 0.54, and 0.56). In contrast, transplantation in very good partial or complete response significantly favored melphalan 140 mg/m(2) 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(2) and melphalan 140 mg/m(2) 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(2) or melphalan 140 mg/m(2) for key transplant outcomes (NCT01362972).
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hal-04412109 , version 1 (23-01-2024)

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W Auner Holger, Simona Iacobelli, Giulia Sbianchi, Cora Knol-Bout, Didier Blaise, et al.. 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. Haematologica, 2018, Haematologica, 103, pp.514-521. ⟨10.3324/haematol.2017.181339⟩. ⟨hal-04412109⟩

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