Table 4.

Randomized studies of tandem autologous stem cell transplantation (ASCT) in newly diagnosed multiple myeloma.

CR/VGPR Rate (%)EFSOS
StudyNAgeRegimenMaintenanceSingleTandemSingleTandemSingleTandemComment
*Statistically significant 
Abbreviations: ASCT, autologous stem cell transplantation; α IFN, alpha interferon; β2M, β2-microglobulin; CR, complete remission; CT, chemotherapy; del 13, deletion of 13; EFS, event free survival; MEL, melphalan; OS, overall survival; TBI, total body irradiation; nCR, near CR (same as CR except immunofixation positivity); NYR, not yet reached; PR, partial remission; pts, patients; VGPR, very good PR (> 90% reduction in serum monoclonal protein; BU, busulfan. 
Attal16  399 ≤ 60 MEL 140 +TBI vs MEL 140 → MEL 140 + TBI α IFN 42 50 25 30* 48 58* Greatest benefit of 2nd ASCT in pts in ≤ VGPR after 1st 
Fermand17  277 ≤ 55 MEL 140 vs MEL 140 → CT + TBI  39 37 31 33 – –  
Cavo18  268 ≤ 60 MEL 200 vs MEL 200 → MEL + BU  38 48 21 31 – – Greatest benefit of 2nd ASCT in pts in ≤ nCR after first 
Goldschmidt19  268 ≤ 65 MEL 200 vs MEL 200 → MEL 200 α IFN – – 22 NYR* – – No effect of del 13q 
Sonneveld20  303 ≤ 65 MEL 70 x 2 vs MEL 70 x 2 → CY + TBI α IFN 13 28* 20 22* 55 50 Prognostic factors β2M, del 13q, abnormal 1p 
CR/VGPR Rate (%)EFSOS
StudyNAgeRegimenMaintenanceSingleTandemSingleTandemSingleTandemComment
*Statistically significant 
Abbreviations: ASCT, autologous stem cell transplantation; α IFN, alpha interferon; β2M, β2-microglobulin; CR, complete remission; CT, chemotherapy; del 13, deletion of 13; EFS, event free survival; MEL, melphalan; OS, overall survival; TBI, total body irradiation; nCR, near CR (same as CR except immunofixation positivity); NYR, not yet reached; PR, partial remission; pts, patients; VGPR, very good PR (> 90% reduction in serum monoclonal protein; BU, busulfan. 
Attal16  399 ≤ 60 MEL 140 +TBI vs MEL 140 → MEL 140 + TBI α IFN 42 50 25 30* 48 58* Greatest benefit of 2nd ASCT in pts in ≤ VGPR after 1st 
Fermand17  277 ≤ 55 MEL 140 vs MEL 140 → CT + TBI  39 37 31 33 – –  
Cavo18  268 ≤ 60 MEL 200 vs MEL 200 → MEL + BU  38 48 21 31 – – Greatest benefit of 2nd ASCT in pts in ≤ nCR after first 
Goldschmidt19  268 ≤ 65 MEL 200 vs MEL 200 → MEL 200 α IFN – – 22 NYR* – – No effect of del 13q 
Sonneveld20  303 ≤ 65 MEL 70 x 2 vs MEL 70 x 2 → CY + TBI α IFN 13 28* 20 22* 55 50 Prognostic factors β2M, del 13q, abnormal 1p 
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