title: Refractory and relapsing multiple myeloma treated by blood stem cell transplantation.
abstract: Between June 1989 and June 1992, 12 patients with advanced multiple myeloma underwent peripheral blood stem cell autotransplantation after high-dose chemotherapy and radiotherapy. The conditioning regimen included melphalan (140 mg/m2), high-dose cyclophosphamide (120 mg/kg), methylprednisolone (2 g daily x 7), and total body irradiation (9-12 Gy). Transplant morbidity included severe mucositis (n = 7) and acute renal failure (n = 2) related to infusion of the stem cells. Engraftment was delayed (n = 4) in this heavily pretreated population, and two patients had complete graft failure. Despite the advanced nature and chemotherapy-refractory state of their disease, 11 of 11 evaluable patients achieved an objective response. Six patients survived to leave the hospital, and four remain alive--one died of acute leukemia induced by prior melphalan exposure. Three of the four are relapse-free at a median of 24.9 months (range, 18-28 months). Some patients with advanced refractory multiple myeloma can achieve objective responses from highdose chemoradiotherapy with peripheral blood stem cell rescue. Harvesting peripheral blood stem cells from high-risk patients early in their disease for later use may decrease the risk of graft failure. Peripheral blood stem cell transplantation after high-dose chemotherapy and total body irradiation can produce durable responses in patients with advanced refractory myeloma.
authors.affiliation: Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN 55905.
authors.forename: M A
authors.initials: MA
authors.lastname: Gertz
authors.forename: A A
authors.initials: AA
authors.lastname: Pineda
authors.forename: M G
authors.initials: MG
authors.lastname: Chen
authors.forename: L
authors.initials: L
authors.lastname: Letendre
authors.forename: P R
authors.initials: PR
authors.lastname: Greipp
authors.forename: L A
authors.initials: LA
authors.lastname: Solberg
authors.forename: T E
authors.initials: TE
authors.lastname: Witzig
authors.forename: J P
authors.initials: JP
authors.lastname: Garton
authors.forename: D J
authors.initials: DJ
authors.lastname: Inwards
authors.forename: M R
authors.initials: MR
authors.lastname: Litzow
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007937:Leukapheresis; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D009092:Mucous Membrane; D009101:Multiple Myeloma / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D010612:Pharyngitis / Q000209:etiology; D012008:Recurrence; D014916:Whole-Body Irradiation
chemical_list: D003520:Cyclophosphamide; D008558:Melphalan; D008775:Methylprednisolone