High-dose chemotherapy with carboplatin, cyclophosphamide and etoposide and autologous transplantation for multiple myeloma relapsing after a previous transplant

Abstract

Eighteen extensively pre-treated patients (35–73 years, median 46) with relapsed multiple myeloma received salvage chemotherapy with 6 g/m² cyclophosphamide, 800 mg/m² carboplatin, and 1800 mg/m² etoposide (CCV) as a 96-h continuous infusion followed by autologous peripheral blood stem cells. The median number of prior chemotherapy regimens was five (range 4–10), including at least one autograft. Four patients died of toxicity, and one developed dialysis-dependent renal failure, while the others tolerated CCV well. Three of six patients with pre-transplant creatinine of >1 mg/dl died of toxicity compared with one of 12 with creatinine ⩽1 mg/dl (P = 0.083, Fisher’s exact test). Three of four patients treated with four previous regimens showed >50% reduction in tumor compared with one of 14 treated with >4 regimens (P = 0.02, Fisher’s exact test). At the last follow-up, five patients were alive at 8–24 months (median 13) with stable (n = 1) or progressive (n = 4) disease, and nine had died of progressive disease at 2.5–15 months (median 7). We conclude that CCV chemotherapy with autografting is tolerated well by extensively pre-treated myeloma patients provided the pre-transplant creatinine is normal, but toxicity in patients with abnormal renal function is high. The efficacy in multiply relapsed disease is poor, with response in only 22% of patients. CCV may deserve further evaluation early in the course of myeloma in patients with normal renal function.