To evaluate the outcomes of salvage third autologous stem cell transplantation (ASCT) in patients with relapsed multiple myeloma. We analyzed 570 patients who had undergone a third ASCT between 1997 and 2010 (European Society for Blood and Marrow Transplantation data), of whom 482 patients underwent tandem ASCT and a third ASCT at first relapse (AARA group) and 88 patients underwent an upfront ASCT with second and third transplantations after subsequent relapses (ARARA group). With a median follow-up after salvage third ASCT of 61 months in the AARA group and 48 months in the ARARA group, the day +100 nonrelapse mortality in the 2 groups was 4% and 7%, the incidence of second primary malignancy was 6% and 7%, the median progression-free survival was 13 and 8 months, and median overall survival (OS) was 33 and 15 months. In the AARA group, according to the relapse-free interval (RFI) from the second ASCT, the median OS after the third ASCT was 17 months if the RFI was <18 months, 37 months if the RFI was between 18 and 36 months, and 64 months if the RFI was ≥36 months (P < .001). In the ARARA group, the median OS after the third ASCT was 7 months if the RFI was <6 months, 13 months if the RFI was between 6 and 18 months, and 27 months if the RFI was ≥18 months (P < .001). In a multivariate analysis of the AARA group, the favorable prognostic factor was an RFI after second ASCT of ≥18 months. Progressive disease and a Karnofsky Performance Status score of <70 at third ASCT were unfavorable factors. A salvage third ASCT is of value for patients with relapsed myeloma, particularly for those with a long duration of response and chemosensitive disease at the time of transplantation.

Department of Hematology Azienda Ospedaliera S Croce e Carle Cuneo Italy

Department of Hematology Azienda Ospedaliera SS Antonio e Biagio Alessandria Italy

Department of Hematology Centre Henri Becquerel Rouen France

Department of Hematology Centre Hospitalier Universitaire de Dijon Dijon France

Department of Hematology Charles University Hospital Hradec Králové Czech Republic

Department of Hematology Charles University Hospital Prague Czech Republic

Department of Hematology Eppendorf University Hospital Hamburg Germany

Department of Hematology Gustave Roussy Institut de Cancérologie Villejuif France

Department of Hematology Hannover Medical School Hannover Germany

Department of Hematology Hôpital La Miletrie Poitiers France

Department of Hematology Hôpital Saint Antoine Paris France

Department of Hematology Institut Paoli Calmettes Marseille France

Department of Hematology Klinikum Nürnberg Nürnberg Germany

Department of Hematology Klinikum Oldenburg Oldenburg Germany

Department of Hematology Klinkum Rechts der Isar Munich Germany

Department of Hematology Royal Marsden Hospital London Surrey United Kingdom

Department of Hematology Sahlgrenska University Hospital Goeteborg Sweden

Department of Hematology University Hospital Brno Brno Czech Republic

Department of Hematology University of Heidelberg Heidelberg Germany

Department of Internal Medicine 2 Universitätsklinikum Würzburg Würzburg Germany

Department of Statistics Rome University Tor Vergata Rome Italy

European Society for Blood and Marrow Transplantation Leiden The Netherlands

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