title: High-dose chemotherapy with carboplatin, cyclophosphamide and etoposide and autologous transplantation for multiple myeloma relapsing after a previous transplant.
abstract: Eighteen extensively pre-treated patients (35-73 years, median 46) with relapsed multiple myeloma received salvage chemotherapy with 6 g/m2 cyclophosphamide, 800 mg/m2 carboplatin, and 1800 mg/m2 etoposide (CCV) as a 96-h continuous infusion followed by autologous peripheral blood stem cells. The median number of prior chemotherapy regimens was five (range 4-10), including at least one autograft. Four patients died of toxicity, and one developed dialysis-dependent renal failure, while the others tolerated CCV well. Three of six patients with pre-transplant creatinine of > 1 mg/dl died of toxicity compared with one of 12 with creatinine < or = 1 mg/dl (P = 0.083, Fisher's exact test). Three of four patients treated with four previous regimens showed > 50% reduction in tumor compared with one of 14 treated with > 4 regimens (P = 0.02, Fisher's exact test). At the last follow-up, five patients were alive at 8-24 months (median 13) with stable (n = 1) or progressive (n = 4) disease, and nine had died of progressive disease at 2.5-15 months (median 7). We conclude that CCV chemotherapy with autografting is tolerated well by extensively pre-treated myeloma patients provided the pre-transplant creatinine is normal, but toxicity in patients with abnormal renal function is high. The efficacy in multiply relapsed disease is poor, with response in only 22% of patients. CCV may deserve further evaluation early in the course of myeloma in patients with normal renal function.
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock 72212, USA.
authors.forename: J
authors.initials: J
authors.lastname: Mehta
authors.forename: G
authors.initials: G
authors.lastname: Tricot
authors.forename: S
authors.initials: S
authors.lastname: Jagannath
authors.forename: K R
authors.initials: KR
authors.lastname: Desikan
authors.forename: D
authors.initials: D
authors.lastname: Siegel
authors.forename: S
authors.initials: S
authors.lastname: Singhal
authors.forename: N
authors.initials: N
authors.lastname: Munshi
authors.forename: D
authors.initials: D
authors.lastname: Vesole
authors.forename: S
authors.initials: S
authors.lastname: Mattox
authors.forename: D
authors.initials: D
authors.lastname: Bracy
authors.forename: B
authors.initials: B
authors.lastname: Barlogie
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence
chemical_list: D005047:Etoposide; D003520:Cyclophosphamide; D016190:Carboplatin