Idarubicin containing regimen in multiple myeloma: preliminary results of a pilot study using a modified "TANDEM" transplant program.
Tandem autologous transplant actually represents a challenge in multiple myeloma treatment, but the best conditioning regimen is still under investigation. With the aim of evaluating the feasibility of a modified tandem transplant strategy, we treated 10 multiple myeloma patients after conventional first line chemotherapy with a two step conditioning regimen consisting of high-dose melphalan (200 mg/m2) followed by high-dose melphalan (180 mg/m2) together with indarubicin (15 mg/sqm2 c.i. x 3 days) both with peripheral stem cell support. At first transplant, the median age wasyears, performance status was good and disease status was CR in 2 patients and PR in the rest. At the end of the first transplant, 70% of patients achieved CR and only mild toxicity was observed. After the second transplant further improvement of the response rate was obtained with 90% CR. However, we observed three toxic early infection-related deaths from CMV and legionella pneumonia at day + 17, +26, +54 after transplantation. Although this schedule seems to be effective in terms of response rate, the 30% TRM imposes an anthracycline dose-reduction with careful patient selection. This approach could reduce the toxic effects and maintain the efficacy of therapy at the same time.
Martinelli
G
G
Department of Hematology-Oncology, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy. giovanni.martinelli@ieo.it
Agazzi
A
A
Laszlo
D
D
Santoro
P
P
Mancuso
P
P
Pruneri
G C
GC
Greco
P
P
Bertolini
F
F
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000633:toxicity; D003586:Cytomegalovirus Infections / Q000209:etiology; D005260:Female; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage* / Q000633:toxicity; D007877:Legionnaires' Disease / Q000209:etiology; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000188:drug therapy* / Q000628:therapy; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D010865:Pilot Projects; D012074:Remission Induction; D019172:Transplantation Conditioning / Q000379:methods; D014182:Transplantation, Autologous
D008558:Melphalan; D015255:Idarubicin