Melphalan 140 mg/m2 or 200 mg/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
(2018) In Haematologica 103(3). p.514-521- Abstract
Melphalan at a dose of 200 mg/m2 is standard conditioning prior to autologous hematopoietic stem cell transplantation for multiple mulholger, 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... (More)
Melphalan at a dose of 200 mg/m2 is standard conditioning prior to autologous hematopoietic stem cell transplantation for multiple mulholger, 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).
(Less)
- author
- publishing date
- 2018-02-28
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Haematologica
- volume
- 103
- issue
- 3
- pages
- 514 - 521
- publisher
- Ferrata Storti Foundation
- external identifiers
-
- scopus:85042786477
- pmid:29217776
- ISSN
- 0390-6078
- DOI
- 10.3324/haematol.2017.181339
- language
- English
- LU publication?
- no
- id
- 3f5f1eb6-03ab-4a08-949d-b05b33439691
- date added to LUP
- 2018-04-12 13:51:29
- date last changed
- 2024-06-25 15:40:04
@article{3f5f1eb6-03ab-4a08-949d-b05b33439691,
abstract = {{<p>Melphalan at a dose of 200 mg/m<sup>2</sup> is standard conditioning prior to autologous hematopoietic stem cell transplantation for multiple mulholger, but a dose of 140 mg/m<sup>2</sup> is often used in clinical practice in patients perceived to be at risk of excess toxicity. To determine whether melphalan 200 mg/m<sup>2</sup> and melphalan 140 mg/m<sup>2</sup> 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<sup>2</sup> (n=245) and melphalan 200 mg/m<sup>2</sup> (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<sup>2</sup> in patients transplanted in less than partial response (adjusted hazard ratios for melphalan 200 mg/m<sup>2</sup> versus melphalan 140 mg/m<sup>2</sup>: 0.5, 0.54, and 0.56). In contrast, transplantation in very good partial or complete response significantly favored melphalan 140 mg/m<sup>2</sup> 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<sup>2</sup> and melphalan 140 mg/m<sup>2</sup> 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<sup>2</sup> or melphalan 140 mg/m<sup>2</sup> for key transplant outcomes (NCT01362972).</p>}},
author = {{Auner, Holger W. and Iacobelli, Simona and Sbianchi, Giulia and Knol-Bout, Cora and Blaise, Didier and Russell, Nigel H. and Apperley, Jane F. and Pohlreich, David and Browne, Paul V. and Kobbe, Guido and Isaksson, Cecilia and Lenhoff, Stig and Scheid, Christof and Touzeau, Cyrille and Jantunen, Esa and Anagnostopoulos, Achilles and Yakoub-Agha, Ibrahim and Tanase, Alina and Schaap, Nicolaas and Wiktor-Jedrzejczak, Wieslaw and Krejci, Marta and Schönland, Stefan O. and Morris, Curly and Garderet, Laurent and Kröger, Nicolaus}},
issn = {{0390-6078}},
language = {{eng}},
month = {{02}},
number = {{3}},
pages = {{514--521}},
publisher = {{Ferrata Storti Foundation}},
series = {{Haematologica}},
title = {{Melphalan 140 mg/m2 or 200 mg/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}},
url = {{http://dx.doi.org/10.3324/haematol.2017.181339}},
doi = {{10.3324/haematol.2017.181339}},
volume = {{103}},
year = {{2018}},
}