Double Stem Cell Transplant May Benefit Some Myeloma Patients
For patients with multiple myeloma, double autologous stem cell transplantation is associated with better overall survival compared with a single transplantation, according to a new study.
Multiple myeloma is a plasma cell cancer than has a 5-year survival rate of only 31%. Because conventional chemotherapy is not often successful in producing long-term remissions, researchers have been testing high-dose chemotherapy with autologous stem cell transplantation. A handful of trials have examined whether double-intensive therapy, or two successive autologous stem cell transplants, can improve response rates more than a single transplant.
Michel Attal, M.D., and colleagues from the InterGroupe Francophone du Myélome, randomly assigned 399 patients younger than age 60 with stage I, II, or III myeloma to receive high-dose chemotherapy followed by either a single or a double stem cell transplant. For the double transplant group, the median time between transplants was 2.5 months.
There was not a statistically significant difference in complete or partial response rates when analyzed on an intent-to-treat basis. The investigators calculated that the probability that patients would survive event-free for 7 years after diagnosis was 10% in the single-transplant group and 20% in the double-transplant group. The estimated overall 7-year survival rate was 21% in the single-transplant group and 42% in the double-transplant group.
The researchers note that the morbidity and costs of double transplantations justify selectivity in choosing patients who are most likely to benefit from the treatment. "Although our trial demonstrates that double transplantation improves overall survival among patients with myeloma, the absence of a plateau in the curve for event-free survival justifies the development of new strategies to control this disease," the authors wrote.
The study was published in the December 25 issue of the New England Journal of Medicine.
Imaging the Possibilities: Study Examines Whole-Body Scans for Tumor Staging
A combined whole-body scan that includes positron emission tomography (PET) and computed tomography (CT) may more accurately determine a patients stage of disease than magnetic resonance imaging (MRI), a new study suggests.
The properties of MRI make it well-suited for tumor staging, CT scanning is commonly used to evaluate patients with a variety of cancers, and PET scans can provide information on tumor metabolism. Only recently, however, have doctors been able to combine both PET and CT imaging.
To test this dual-modality approach, Gerald Antoch, M.D., and colleagues from the University Hospital Essen, Germany, performed a prospective, blinded study of 98 cancer patients who underwent successive PET/CT scans and whole-body MRI. They found that the overall classification of the primary tumor, regional lymph nodes, and distant metastasis (TNM stage) was correctly determined in 77% of patients with PET/CT and in 54% of patients with MRI. PET/CT more accurately determined tumor stage and lymph node involvement compared with MRI, whereas the performance of the two scans was similar in detecting distant metastases.
"Introduction of PET/CT or whole-body MRI as the first line of investigation would lead to significant changes in the management of patients with cancer," wrote editorialists Lennart Blomqvist, M.D., Ph.D., and Michael R. Torkzad, M.D., of the Karolinska Hospital, Stockholm, Sweden. "While these results are intriguing, additional studies are needed to establish the role of whole-body imaging for tumor staging in oncology practice."
The study was published in the December 24/31 issue of the Journal of the American Medical Association.
![]() |
||||
|
Oxford University Press Privacy Policy and Legal Statement |