Advertisement

Peripheral Blood Progenitor Cell Transplantation in Multiple Myeloma Following High-Dose Melphalan-Based Therapy

  • H. Goldschmidt
  • U. Hegenbart
  • M. Wallmeier
  • S. Hohaus
  • R. Engenhart
  • M. Wannenmacher
  • R. Haas
Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 144)

Abstract

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.

Keywords

Multiple Myeloma Total Body Irradiation Hematopoietic Progenitor Cell Autologous Bone Marrow Transplantation Peripheral Blood Progenitor Cell 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Alexanian R, Dimopoulos M (1994) The treatment of multiple myeloma. N Engl J Med 330:484–489PubMedCrossRefGoogle Scholar
  2. 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
  3. Attal M, Harousseau JL, Stoppa et al (1996) High dose therapy in multiple myeloma: final analysis of a prospective randomized study of the “Intergroup Francais du Myeloma” (IFM 90). N Engl J Med 335:91–97PubMedCrossRefGoogle Scholar
  4. 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
  5. Cunningham D, Paz-Ares L, Milan S et al (1994) High-dose melphalan and autologous bone marrow transplantation as consolidation in previously untreated myeloma. J Clin Oncol 12:759–763PubMedGoogle Scholar
  6. Durie B, Salmon S (1975) A clinical staging system for multiple myeloma. Cancer 36:842–852PubMedCrossRefGoogle Scholar
  7. Gregory WM, Richards MA, Malpas JS (1992) Combination therapy versus melphalan and prednisolone in the treatment of multiple myeloma: an overview of published trials. J Clin Oncol 10:334–342PubMedGoogle Scholar
  8. Hohaus S, Goldschmidt H, Ehrhardt R et al (1993) Successful autografting following myeloablative conditioning therapy with blood stem cells mobilized by chemotherapy plus rhG-CSF. Exp Hematol 21:508–514PubMedGoogle Scholar
  9. Jagannath S, Barlogie B (1992) Autologous bone marrow transplantation for multiple myeloma. Hematol Oncol Clin North Am 6:451–462Google Scholar
  10. McElwain TJ, Powles RL (1983) High dose intravenous melphalan for plasma cell leukemia and myeloma. Lancet 2:822–824PubMedCrossRefGoogle Scholar
  11. 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
  12. Murea S, Goldschmidt H, Hahn U et al (1997) Successful collection and transplantation of peripheral blood stem cells in cancer patients using large-volume leukapheresis. J Clin Apheresis 11:185–194CrossRefGoogle Scholar
  13. Samson D (1996) Principles of chemotherapy and radiotherapy. In: Gahrton M, Durie BGM (eds) Multiple myeloma. Arnold, London, pp 108–129Google Scholar
  14. Vesole DH, Barlogie B, Jagannath S et al (1994) High-dose therapy for refractory multiple myeloma: improved prognosis with better supportive care and double transplants. Blood 84:950–956PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin · Heidelberg 1998

Authors and Affiliations

  • H. Goldschmidt
    • 1
  • U. Hegenbart
    • 1
  • M. Wallmeier
    • 1
  • S. Hohaus
    • 1
  • R. Engenhart
    • 2
  • M. Wannenmacher
    • 2
  • R. Haas
    • 1
  1. 1.Department of Internal Medicine VUniversity of HeidelbergHeidelbergGermany
  2. 2.Department of RadiologyUniversity of HeidelbergHeidelbergGermany

Personalised recommendations