Treatment of multiple myeloma by high dose chemotherapy, total body irradiation and autologous blood stem cell autograft.
Fourteen patients with stage III aggressive multiple myeloma were treated by high dose chemotherapy (carmustine, etoposide and melphalan) and total body irradiation. This procedure was followed by autografting using blood stem cells previously collected by leukapheresis performed during recovery of cytotoxic drug-induced bone marrow aplasia. One patient died from cerebral bleeding at day 40. All other patients, including 9 whose disease was refractory to conventional treatments, achieved an impressive tumor mass reduction (over 90% in 12 cases). Two patients relapsed and died 12 and 15 months after the graft; another one relapsed but is still alive at 24 months. Two to 23 months (median 12 months) after the autograft, 10 patients are well either in apparent complete remission (2 cases) or with a state of stable minimal residual disease. Autologous blood-derived hematopoietic stem cells induced successful and sustained engraftment in the 13 evaluable patients. The cells collected by leukapheresis were studied for clonal Ig genes rearrangements indicative of circulating tumoral cells (or clonal B precursors) and none were found. Although preliminary, these results appear promising and high dose chemotherapy followed by autologous blood stem cell graft deserves consideration in young patients with multiple myeloma.
Fermand
J P
JP
Service d'Hématologie et d'Immunohématologie, Hôpital Saint-Louis, INSERM U108, Paris, France.
Lévy
Y
Y
Gerota
J
J
Benbunan
M
M
Cosset
J M
JM
Castaigne
S
S
Seligmann
M
M
Brouet
J C
JC
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002330:Carmustine / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005047:Etoposide / Q000008:administration & dosage; D005069:Evaluation Studies as Topic; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D012074:Remission Induction; D014182:Transplantation, Autologous; D014916:Whole-Body Irradiation
D005047:Etoposide; D008558:Melphalan; D002330:Carmustine