Background.
Survival of myeloma
patients has improved considerably in the past decade. However, limited data are available on their long-term outcome. We analysed the data of 225 consecutive
patients who underwent autologous
stem cell transplantation (ASCT) at our centre.
Methods. Between April 1990 and December 2013, a total of 225
patients with
multiple myeloma (median age 53 years, range 27–67 years, 69.3%
men) underwent ASCT. High-
dose melphalan 200 mg/m2 was used for conditioning. Before
transplant, the
patients received induction
therapy with novel agents (
thalidomide and
dexamethasone, or
lenalidomide and
dexamethasone, or
bortezomib and
dexamethasone); or
vincristine,
doxorubicin,
dexamethasone; or
alkylating agents (
vincristine,
melphalan,
cyclophosphamide and
prednisolone; or
melphalan and
prednisolone). The response to
transplant was evaluated using the European
Bone Marrow Transplant criteria, and an
intention-to-treat
analysis was done. Results. Four-fifths (79.6%) of our
patients had Durie
Salmon Stage (DSS) IIIA and nearly a quarter (24%) of them had International Stage III
disease. Before the
transplant, 80.4% of
patients had chemosensitive
disease. The median interval from
diagnosis to
transplant was 10 months (range 2–128 months). Following ASCT, 197 (87.5%)
patients responded. Complete response was obtained in 54.7%, very good partial response in 19% and partial response in 13.8%. At a median follow-up of 90 months (range 18–266 months), the median
progression-free survival (PFS) and overall
survival (OS) were 32 and 85.5 months, respectively. The estimated PFS and OS
at 10 years were 29.7% and 43.6%, respectively. On
multivariate analysis, the presence of extramedullary
disease (HR 3.05, p<0.001), and ISS III (HR 0.50, p<0.02)