Impact of tandem autologous stem cell transplantation and response to transplant in the outcome of multiple myeloma

We retrospectively analysed data from 85 patients with MM submitted to ASCT in our centre from 2000 to 2010: 132 ASCT were realized, 80 of them as tandem.After induction, 17.6% were in complete remission (CR), 41.2% in very good partial remission (VGPR) and 41.2% in partial remission (PR). After transplant 44.7% were in CR, 15.3% in VGPR and 40% in PR. With 22 months (range – 3 to 117 months) of median follow-up, median overall survival (OS) was 43 months and progression-free survival (PFS) 22 months. At 5 years, OS was 45.3% (36.7-53.9%, 95%) and PFS 24.5% (18-31%, 95%). Patients with CR after ASCT had significantly longer PFS as compared to patients with PR (27 vs 7 months; p？=？0.034) but not when compared to patients with VGPR (27 vs 19 months, p？=？0.485). The tandem approach represented an advantage in OS and PFS when compared to only one ASCT (31 vs 19 months - p？=？0.018, and 40 vs 31 - p？=？0.04, respectively).Our results highlight the impact of response to transplant in patients PFS and tandem modality showed to carry better PFS and OS then the single transplant.Multiple Myeloma (MM) is a neoplasm characterized by abnormal proliferation of plasma cells and secretion of monoclonal immunoglobulin in blood and/or urine [1,2]. It is responsible for 1% of cancers in general and 10-15% of hematologic, accounting for 20% of all deaths due to hematologic malignancies. It affects 4.3/100000 persons per year worldwide and the incidence increases with age (median age 65 years). Around 90% of cases occur after the age of 50. It is more common in male than females (1.4:1) and in Afro-Americans compared to Caucasians (2:1) [1,3].Signs and symptoms vary greatly and clinical presentation may range from cases that are detected on routine screenings to severe hematologic emergencies [1]. In addition to the classic prognostic classification systems DurieSalmon Staging (DSS) [4] and International Staging System (ISS) [5], currently the stratification risk according to cytogenetic