Reduced intensity conditioning with thiotepa, fludarabine, and melphalan is effective in advanced multiple myeloma.

Abstract

Fifty-three patients with multiple myeloma (MM) underwent an allogeneic stem cell transplant (HSCT) from their HLA identical siblings using a reduced-intensity conditioning consisting of thioteopa 5 mg/kg, fludarabine 90 mg/m(2), and melphalan 80 mg/m(2). Their median age was 52 years (range 38 - 68) and the interval from diagnosis 12 months. Forty-three patients (82%) had advanced disease and 33 had previously been treated with high-dose therapy with one (N = 21), or more (N = 12) autologus transplants. Ten (18%) had their allograft programmed after induction chemotherapy. The majority (N = 44) received peripheral blood as stem cell source. Acute graft-versus-host disease (GVHD) grade II - IV developed in 45%, but grade III - IV in only 5%. Cumulative incidence of chronic GVHD was 64%. Sixty-two per cent were in complete remission (CR) following transplantation. Transplant-related mortality was 13%. Relapse incidence was 32%. With a median follow-up of 22 months, 3-year overall survival is 45% and progression free survival (PFS) 37%. The thiotepa, fludarabine, and melphalan conditioning regimen can produce remissions in the majority of MM patients with a limited transplant mortality rate. When used as first line treatment the results of transplantation appear even more encouraging.

• Authors: Ignazio Majolino, Marina Davoli, Ellen Carnevalli, Anna Locasciulli, Paolo Di Bartolomeo, Rosanna Scimè, Paolo Corradini, Carmine Selleri, Franco Narni, Maurizio Musso, Marco Bregni, Attilio Olivieri, Paolo De Fabritiis, Luigi Pogliani, Jorge E Duque Arbelaez, Carla Ruscio, Andrea Bacigalupo, Gitmo Institutions
• Journal: Leukemia & lymphoma (Leuk Lymphoma) Vol. 48 Issue 4 Pg. 759-66 (Apr 2007) ISSN: 1042-8194 [Print] United States
• PMID: 17454635 (Publication Type: Journal Article)

Chemical References

• Myeloablative Agonists
• Thiotepa
• Vidarabine
• fludarabine
• Melphalan

Topics

• Adult
• Aged
• Disease-Free Survival
• Female
• Humans
• Male
• Melphalan (administration & dosage)
• Middle Aged
• Multiple Myeloma (drug therapy)
• Myeloablative Agonists (administration & dosage)
• Stem Cell Transplantation (methods)
• Thiotepa (administration & dosage)
• Transplantation Conditioning (methods)
• Transplantation, Homologous
• Vidarabine (administration & dosage, analogs & derivatives)