Table 2.
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);
In patients who actually received 1 or 2 ASCT