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High-dose therapy and autologous peripheral blood stem cells transplantation followed by a very low reduced intensity regimen with fludarabine + cyclophosphamide and allograft improve complete remission rate in de novo multiple myeloma patients.
- Source :
-
American journal of hematology [Am J Hematol] 2006 Dec; Vol. 81 (12), pp. 973-8. - Publication Year :
- 2006
-
Abstract
- The recent development of reduced intensity conditioning and allotransplantation (RICT) has opened a new way to assure engraftment of donor cells while reducing early transplant-related mortality. We evaluated the combination of high-dose therapy and autologous peripheral blood stem cells transplantation (APBSCT) followed by RICT to extend the benefit of allografting procedures in de novo multiple myeloma (MM) patients. Fifteen subjects with stage III MM (median age 51 years, range 40-57) received high dose melphalan (200 mg/m(2)) followed by APBSCT previously collected after cyclophosphamide (4 g/m(2)) and granulocyte colony-stimulating factor (G-CSF). After 3-4 months from APBSCT, the patients underwent RICT, consisting of fludarabine 30 mg/m(2) + cyclophosphamide 300 mg/m(2) on days -4, -3, and -2. Acute graft-versus-host disease (GVHD) occurred in 2 patients; 6 patients developed chronic GVHD; 4 patients developed CMV antigenemia and were treated pre-emptively with ganciclovir. No transplant related mortality was shown. Response was simultaneously measured by both electrophoresis (EP) and immunofixation (IF); when IF was negative, patients were classified in complete remission (CR) and when it remained positive, near CR (nCR). After a median follow up of 44 months post APBSCT, 100 and 43% of patients are still alive and progression-free, respectively. Overall, the CR + nCR rate after dose-reduced allograft was enhanced from 26.7 to 73.3%. A correlation not statistically significant between GVHD and remission was found. In conclusion, an up-front tandem strategy with a very low reduced intensity-conditioning regimen for allografting following autografting is feasible and induces high CR/nCR rate in MM.
- Subjects :
- Adolescent
Adult
Aged
Cyclophosphamide administration & dosage
Disease-Free Survival
Female
Follow-Up Studies
Humans
Male
Melphalan administration & dosage
Middle Aged
Multiple Myeloma mortality
Myeloablative Agonists
Remission Induction
Retrospective Studies
Survival Rate
Transplantation, Autologous
Vidarabine administration & dosage
Vidarabine analogs & derivatives
Antineoplastic Combined Chemotherapy Protocols administration & dosage
Multiple Myeloma therapy
Peripheral Blood Stem Cell Transplantation methods
Transplantation Conditioning methods
Subjects
Details
- Language :
- English
- ISSN :
- 0361-8609
- Volume :
- 81
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- American journal of hematology
- Publication Type :
- Academic Journal
- Accession number :
- 16888786
- Full Text :
- https://doi.org/10.1002/ajh.20677