Autologous peripheral blood stem cell transplantation in multiple myeloma using oral versus I.V. melphalan
Autologous peripheral blood stem cell transplantation is the therapy of choice for the treatment of multiple myeloma (MM) patients younger than 70 years old. Between August 1993 and November 2004, 54 patients with MM were autografted after conditioning with high-dose oral melphalan 140 mg/m2 in combination with etoposide and carmustine (28 patients) or with high-dose melphalan 200 mg/m2 I.V. (26 patients). The oral and IV melphalan groups were comparable. There were no significant differences in disease-free survival (DFS) and overall survival (OS) between the groups; however, in patients transplanted in remission, OS and DFS were better in the I.V. melphalan group. Four good-prognostic factors were identified: interval between diagnosis and transplant <18 months, number of prior chemotherapy lines ≤2, remission status (complete or partial), and the use of I.V. melphalan. In conclusion, I.V. melphalan is the therapy of choice for conditioning patients with MM who are in remission.
KeywordsStem cell autotransplants Multiple myeloma Oral and I.V. melphalan
This study was approved by the ethical committees of the participant hospitals and is in accordance with the Helsinki Declaration of 1975 and complies with the current health and research laws of México.
- 5.Bergsagel DE (1989) Melphalan/prednisone vs drug combinations for plasma cell myeloma. Eur J Haematol 43(Suppl 51):117–123Google Scholar
- 11.Vela-Ojeda J, Sanchez-Cortes E, Ayala-Sanchez M, Garcia-Chavez J, García-Ruiz Esparza MA, Tripp-Villanueva F et al (1998) Treatment of relapse and refractory multiple myeloma (MM) with intermediate doses of oral melphalan, dexamethasone and GM-CSF (M-80) versus VAD chemotherapy. Blood 92(10) Suppl 1, 284b, abstract # 4225Google Scholar
- 14.Moreau P, Facon T, Attal M (2002) Comparison of 200 mg/m2 melphalan and 8 Gy total body irradiation plus 140 mg/m2 as conditioning regimens for peripheral blood stem cell transplantation in patients with newly diagnosed multiple myeloma. Final analysis of the IFM 95-02 randomized trial. Blood 99:731–735PubMedCrossRefGoogle Scholar
- 15.Reece PA, Kostasek D, Morris RG (1986) The effect of food on oral melphalan absorption. Cancer Chemother Pharmacol 49:1318–1321Google Scholar
- 16.Ruiz-Argüelles A (1992) Flow cytometry in the clinical laboratory. Principles, applications and problems. Ann Biol Clin 50:735–743Google Scholar
- 21.Vela-Ojeda J, García-Ruiz Esparza MA, Rosas-Cabral A, Padilla-González Y, García-Chavez J, Tripp-Villanueva F et al (2002) Intermediate doses of melphalan and dexamethasone are better than VAD chemotherapy for the treatment of primary plasma cell leukemia. Ann Hematol 81:262–267Google Scholar