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.
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References
Alexanian R, Dimopoulos M (1994) The treatment of multiple myeloma. N Engl J Med 330:484–489
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 protocol
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 335:91–97
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 86:207a
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 12:759–763
Durie B, Salmon S (1975) A clinical staging system for multiple myeloma. Cancer 36:842–852
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 10:334–342
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 21:508–514
Jagannath S, Barlogie B (1992) Autologous bone marrow transplantation for multiple myeloma. Hematol Oncol Clin North Am 6:451–462
McElwain TJ, Powles RL (1983) High dose intravenous melphalan for plasma cell leukemia and myeloma. Lancet 2:822–824
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 322–352
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 11:185–194
Samson D (1996) Principles of chemotherapy and radiotherapy. In: Gahrton M, Durie BGM (eds) Multiple myeloma. Arnold, London, pp 108–129
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 84:950–956
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© 1998 Springer-Verlag Berlin · Heidelberg
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Goldschmidt, H. et al. (1998). Peripheral Blood Progenitor Cell Transplantation in Multiple Myeloma Following High-Dose Melphalan-Based Therapy. In: Advances in Hematopoietic Stem Cell Transplantation and Molecular Therapy. Recent Results in Cancer Research, vol 144. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-46836-0_4
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DOI: https://doi.org/10.1007/978-3-642-46836-0_4
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