Peripheral Blood Progenitor Cell Transplantation in Multiple Myeloma Following High-Dose Melphalan-Based Therapy
The objective of our study was to evaluate the efficacy and toxicity of a high-dose melphalan-based therapy with or without total body irradiation (TBI) followed by peripheral blood progenitor cell (PBPC) transplantation in patients with multiple myeloma. Between June 1992 and June 1996, 104 patients (71 male, 33 female) with a median age of 51 years (range 30–65 years) underwent transplantation at our center. PBPC were mobilized using high-dose chemotherapy followed by treatment with G-CSF. Fifty patients were treated with TBI+melphalan 140 mg/m2 while 54 patients received melphalan 200 mg/m2. Following PBPC autografting, the median time to attainment of platelets ≥20×109/l and neutrophils ≥0.5×109/l was 11 and 14 days, with no difference between the treatment groups. In the TBI group significantly longer periods of total parenteral nutrition were required due to the occurrence of severe mucositis. Two patients from the TBI group died of transplantation-related complications. Following high-dose treatment, remission state improved in 43 out of 102 patients. No statistically significant advantage in reaching complete or partial remission was observed with TBI+high-dose melphalan compared to the treatment with high-dose melphalan alone. The optimal high-dose treatment, with particular reference to the inclusion or omission of TBI, should be prospectively investigated.
KeywordsMultiple Myeloma Total Body Irradiation Hematopoietic Progenitor Cell Autologous Bone Marrow Transplantation Peripheral Blood Progenitor Cell
Unable to display preview. Download preview PDF.
- Attal M (1993) A randomized study testing the effect of bone marrow/peripheral blood stem cell transplantation or conventional chemotherapy, with or without alpha interferon for aggressive myeloma. EORTC Leukemia Cooperative Group, EBMT Myeloma Study Group, French Myeloma Study Groups (GEM-POF), study protocolGoogle Scholar
- Barlogie B, Crowley J, Jagannath S et al (1995) Superior outcome after early autotransplantation (AT) with “Total Therapy” (TT) compared to standard SWOG treatment (ST) for multiple myeloma (MM) (Abstr). Blood 86:207aGoogle Scholar
- Jagannath S, Barlogie B (1992) Autologous bone marrow transplantation for multiple myeloma. Hematol Oncol Clin North Am 6:451–462Google Scholar
- Mohrbacher A, Anderson KC (1995) Bone marrow transplantation in multiple myeloma. In: Malpas JS, Bergsagel DE, Kyle RA (eds) Myeloma. Biology and management. Oxford University Press, Oxford, pp 322–352Google Scholar
- Samson D (1996) Principles of chemotherapy and radiotherapy. In: Gahrton M, Durie BGM (eds) Multiple myeloma. Arnold, London, pp 108–129Google Scholar