High-dose chemoradiotherapy and autologous bone marrow transplantation for resistant multiple myeloma.
Seven patients with advanced multiple myeloma, refractory to therapy with alkylating agent-VAD (vincristine-adriamycin-dexamethasone), received a regimen combining high-dose melphalan with total body irradiation supported by autologous bone marrow transplantation. Very rapid, usually greater than 90% tumor mass reduction was achieved in six patients, regardless of prior chemotherapy responsiveness and marrow plasmacytosis up to 30%. Despite signs of early relapse in three patients (median remission duration of all patients, 15 months), five remain alive and well without further cytotoxic therapy from 2 to 21 months (median, 9+ months). Two patients died, one from surgical complications after transplantation and a second due to persistent neutropenia with fatal pneumonia. This treatment provides meaningful disease control for selected patients with resistant myeloma and a poor prognosis.
Barlogie
B
B
Alexanian
R
R
Dicke
K A
KA
Zagars
G
G
Spitzer
G
G
Jagannath
S
S
Horwitz
L
L
D001773:Blood Cells / Q000473:pathology; D016026:Bone Marrow Transplantation; D002452:Cell Count; D003131:Combined Modality Therapy; D006801:Humans; D008558:Melphalan / Q000008:administration & dosage* / Q000627:therapeutic use; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*
D008558:Melphalan