title: Melphalan plus total body irradiation (MEL-TBI) or cyclophosphamide (MEL-CY) as a conditioning regimen with second autotransplant in responding patients with myeloma is inferior compared to historical controls receiving tandem transplants with melphalan alone.
abstract: The role of more intense conditioning for second transplant was evaluated in myeloma patients achieving at least partial remission (PR) after first transplant with melphalan at 200 mg/m2. Forty-three patients received more intensive conditioning for the second transplant. Nineteen patients received cyclophosphamide 120 mg/kg along with melphalan 200 g/m2 (MEL-CY; group 1) while 24 patients received total body irradiation (1125 cGy) in conjunction with melphalan 140 mg/m2 (MEL-TBI; group 2). Forty-three matched control patients were identified from 450 patients receiving melphalan alone for second transplant (MEL200; group 3). Engraftment and toxicities were comparable among the groups with the exception of increased treatment-related mortality of 8% in group 2 compared to none in groups 1 and 3 (P = 0.07). Despite identical CR rates of 74, 71 and 70%, respectively, in groups 1, 2 and 3 (P = 1.0), event-free survival (median: 27, 15 and 61; P < 0.0001) and overall survival (median: 39, 25 and 76 months; P = 0.003) were significantly decreased in patients receiving more intensive conditioning (groups 1 and 2). Lymphocyte recovery, evaluated as a surrogate for immune recovery, was inferior in more intensively treated patients (groups 1 and 2 compared to group 3). Our findings suggest that more intense conditioning appears to have no benefit in patients responding to their first cycle of high-dose therapy and may even be detrimental in this setting. Bone Marrow Transplantation (2000) 25, 483-487.
authors.affiliation: Myeloma and Transplantation Research Center, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
authors.forename: K R
authors.initials: KR
authors.lastname: Desikan
authors.forename: G
authors.initials: G
authors.lastname: Tricot
authors.forename: M
authors.initials: M
authors.lastname: Dhodapkar
authors.forename: A
authors.initials: A
authors.lastname: Fassas
authors.forename: D
authors.initials: D
authors.lastname: Siegel
authors.forename: D H
authors.initials: DH
authors.lastname: Vesole
authors.forename: S
authors.initials: S
authors.lastname: Jagannath
authors.forename: S
authors.initials: S
authors.lastname: Singhal
authors.forename: J
authors.initials: J
authors.lastname: Mehta
authors.forename: D
authors.initials: D
authors.lastname: Spoon
authors.forename: E
authors.initials: E
authors.lastname: Anaissie
authors.forename: B
authors.initials: B
authors.lastname: Barlogie
authors.forename: N
authors.initials: N
authors.lastname: Munshi
mesh_terms: D018952:Antigens, CD34 / Q000378:metabolism; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use* / Q000633:toxicity; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000633:toxicity; D018572:Disease-Free Survival; D005069:Evaluation Studies as Topic; D005334:Fever / Q000139:chemically induced; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D018655:Lymphocyte Count; D008558:Melphalan / Q000008:administration & dosage* / Q000633:toxicity; D009101:Multiple Myeloma / Q000628:therapy*; D011014:Pneumonia / Q000139:chemically induced; D011379:Prognosis; D018805:Sepsis / Q000139:chemically induced; D013280:Stomatitis / Q000139:chemically induced; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000009:adverse effects; D014182:Transplantation, Autologous / Q000009:adverse effects*; D014916:Whole-Body Irradiation; D001613:beta 2-Microglobulin / Q000097:blood
chemical_list: D018952:Antigens, CD34; D018906:Antineoplastic Agents, Alkylating; D001613:beta 2-Microglobulin; D003520:Cyclophosphamide; D008558:Melphalan