Third autologous stem cell transplants for late relapse of multiple myeloma

Double autologous bone marrow transplantation (ABMT) has been reported as an efficient form of consolidation for patients with multiple myeloma (MM). However, few data are available about feasibility and efficacy of a third ASCT in case of relapse. Here we report two patients with MM who received a third ASCT for late relapse (74 and 52 months) after a double ABMT. Both patients were male with IgG gamma MM (stage IIIA according to the Durie Salmon classification). The two patients were in PR > 50% after a first-line treatment. A double ABMT was performed after relapse and patients remained in PR > 50% after double intensification, lasting 71 and 49 months, respectively. The third ASCT was performed 7 and 10 months, after second relapse. One patient needed 15 months to reach 50 000 platelets, however he did not receive any transfusion after day 14. He was in PR > 50%. The other patient was in PR < 50%, 4 months after ABMT with a full hematological reconstitution. For patients with late relapse of MM after double ABMT, a third ABMT was a feasible treatment and patients seem to remain sensitive to high-dose therapy.