Cyclophosphamide (3.6 g/m2) therapy with G-CSF support for resistant myeloma.
BACKGROUND
In myeloma patients resistance to both melphalan- and doxorubicin-containing regimens has been related to very short survival (approximately 6 months). The development of effective regimens combined with a low toxicity rate is mandatory in this patient subgroup.


METHODS
Fourteen resistant myeloma patients were treated with cyclophosphamide (a total of 3.6 g/m2 was delivered in 2 doses on days 1 and 3) and prednisone (2 mg/kg, days 1-4) every month for 4 cycles. G-CSF support was administered to reduce myelosuppression.


RESULTS
This combination was well tolerated. Granulocyte levels fell below 0.1 x 10(9)/L in all patients after a median of 9 days (range 8-11), followed by recovery to 0.5 x 10(9)/L after a median of 12 days from the start of treatment (range 10-13 days). Platelets never fell below 50 x 10(9)/L. All patients were treated on an outpatient basis and only 2 required hospitalization for major complications (pneumonia and heart failure). Response to cyclophosphamide was observed in 6/14 patients: 2 achieved complete remission, 4 showed a 50% or greater reduction of the M-component. Five patients are still in remission after 2, 6, 7, 9 and 10 months; 1 relapsed after 10 months. All patients except one are alive 4-16 months from the start of treatment.


CONCLUSIONS
This schedule may represent a new approach for resistant myeloma, and its very low toxicity allows it to be delivered on an outpatient basis.
Palumbo
A
A
Dipartimento di Medicina ed Oncologia Sperimentale, Università di Torino, Ospedale Molinette, Italy.
Boccadoro
M
M
Bruno
B
B
Triolo
S
S
Pileri
A
A
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003907:Dexamethasone; D004317:Doxorubicin / Q000008:administration & dosage; D004351:Drug Resistance; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006331:Heart Diseases / Q000139:chemically induced; D006417:Hematuria / Q000139:chemically induced; D006562:Herpes Zoster / Q000209:etiology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008297:Male; D015080:Mesna / Q000008:administration & dosage; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000401:mortality; D009503:Neutropenia / Q000139:chemically induced / Q000517:prevention & control* / Q000628:therapy; D011241:Prednisone / Q000008:administration & dosage; D012074:Remission Induction; D016879:Salvage Therapy; D016019:Survival Analysis; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
D007155:Immunologic Factors; D016179:Granulocyte Colony-Stimulating Factor; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D015080:Mesna; D011241:Prednisone