Autologous Stem Cell Transplantation for Multiple Myeloma: Identification of Prognostic Factors Lalit Kumar, Sunu L. Cyriac, Tilak VSVGK Tejomurtula, Ankur Bahl, Bivas Biswas, Ranjit K. Sahoo, Anjali Mukherjee, Omdutt Sharma Abstract Currently, high dose chemotherapy supported by autologous stem cell transplantation (ASCT) is considered a standard treatment approach for multiple myeloma (MM) patients aged 65 years or younger. To evaluate the predictors of outcome after ASCT, we analyzed results of 170 patients. Pretransplant chemosensitive disease and achievement of complete response (CR) were associated with improved outcome. Introduction: The purpose of this study was to evaluate the effect of prognostic factors on the outcome of patients with MM after ASCT. Patients and Methods: We analyzed results of 170 consecutive patients (121 male and 49 female) of MM who underwent ASCT. Patients’ median age was 52 years (range, 26-68 years). High dose melphalan (200 mg/m 2 ) was used for conditioning. One hundred thirty-two patients (77.6%) had evidence of chemosensitive disease before transplant. Response was assessed using European Group for Blood and Bone Marrow Transplantation criteria. Results: Post ASCT 44.7% of patients achieved CR, 24.7% had very good partial response (VGPR), and 21.2% had partial response (PR). Presence of pretransplant chemosensitive disease (CR, VGPR, and PR) and transplant within 12 months of diagnosis for years before 2006 were associated with higher response rates on multivariate analysis. At a median follow-up of 84 months, median overall (OS) and event-free survival (EFS) is 85.5 and 41 months, respectively. Estimated OS and EFS at 60 months is 62  0.04% and 41  0.04%, respectively. Patients who responded to transplant (CR, VGPR, and PR) had a longer OS (P  .001) and EFS (P  .001). Additionally, patients who achieved CR post transplant had a longer OS (P  .001) and EFS (P  .001). Patients who received novel agents for induction pretransplant had a longer OS (P  .001) and EFS (P  .002). Conclusion: Outcome after ASCT is better for myeloma patients with pretransplant chemosensitive disease and those who achieve CR after transplant. Clinical Lymphoma, Myeloma & Leukemia, Vol. 13, No. 1, 32-41 © 2013 Elsevier Inc. All rights reserved. Keywords: Chemosensitive disease, Complete response, Novel Agents, Serum M protein, Transplant outcome Introduction High-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (ASCT) is currently a standard treat- ment approach for multiple myeloma (MM) patients aged 65 years or younger. 1,2 A number of nonrandomized, 3,4 randomized, 5-9 and population-based studies 10 and metaanalyses 11,12 have suggested that this approach is associated with improved response rates, and event-free survival (EFS) compared with conventional chemother- apy. These studies were done before newer and more potent novel agents (eg, immune modulators: thalidomide and lenalidomide, pro- teasome inhibitors— bortezomib) were routinely used. Higher re- sponse rates achieved with use of novel agents, followed by consoli- dation with ASCT 13-15 has led to search for predictors of outcome post ASCT. We started our autologous stem cell transplant program in 1990; our initial results with conventional chemotherapy for in- duction and ASCT have been reported earlier. 16 We have now up- dated our experience and analyzed data on 170 patients of MM treated with ASCT. This report describes the results. Patients and Methods Between April 1990 and June 2010, 170 patients with MM underwent ASCT. Patient characteristics are shown in Table 1. Patients age ranged from 26 to 68 years (median 52 years). There Department of Medical Oncology, Laboratory Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India Submitted: Apr 23, 2012; Revised: Jul 29, 2012; Accepted: Aug 23, 2012; Epub: Oct 22, 2012 Address for correspondence: Lalit Kumar, MD, DM, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 11 00 29, India Fax: 91-11-686 2663; e-mail contact: lalitaiims@yahoo.com Original Study 32 Clinical Lymphoma, Myeloma & Leukemia February 2013 2152-2650/$ - see frontmatter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.clml.2012.08.007