Table 2.

Studies comparing single autologous stem cell transplantation with tandem autologous stem cell transplantation for multiple myeloma.

Reference	N	Regimen	Response	EFS	OS	Comments
Barlogie et al.46	123	EDAP/MEL200 MEL200 or MEL140+TBI (1,125Gy) vs. chemo⌠ IFN-a maintenance till relapse	≥PR Tandem ASCT vs. chemo⌠ 86% vs. 52% P=.0001	Tandem ASCT vs. chemo⌠ Median EFS 49 mo vs. 22 mo P=.0001	Tandem ASCT vs. chemo⌠ Median OS 62 mo vs. 48 mo P=.01	Absence of abnormalities of chromosome 11q and 13 associated with significantly poor EFS and OS
Attal et al.49	399	MEL 140+TBI (8Gy) vs. (tandem arm) MEL140 then MEL140+TBI (8Gy) Both groups received IFN-a maintenance	CR+VGPRƪ Single vs. tandem 49% vs. 63% P=0.01	At 7-yr Single vs. tandem 10% vs. 20% P=0.03	At 7-yr Single vs. tandem 21% vs. 42% P=0.01	Median time between 1st and 2nd ASCT was 2.5 months
Cavo et al.50	321	MEL200 vs. MEL200 MEL120+Bu IFN-a maintenance until relapse in both groups	Single vs. tandem nCR 33% vs. 47% P=0.008	Single vs. tandem median EFS 23 mo vs. 35 mo P=0.001	Single vs. tandem median OS 65 mo vs. 71m P=0.90	Trend for improved OS in tandem ASCT arm in patients failing to achieve at least near CR after 1st ASCT. (7-yr rate 60% vs. 47%; P=0.10)

Legend: E, etoposide; D, dexamethasone; C, cytarabine; P, cisplatin; MEL, melphalan; D, dexamethasone; IFN-a, interferon-alpha; TBI, total-body irradiation; Bu, busulfan EFS, event-free survival; OS, overall survival; CR, complete remission; nCR, near CR

^⌠SWOG 8229 trial VMCP-VBAP & SWOG 8624 trial VMCP/VBAP vs. VMCPP/VBAPP vs. VAD (see Table 1 for details);

^ƪIn patients who actually received 1 or 2 ASCT