title: Busulfan, cyclophosphamide, and etoposide as conditioning for autologous stem cell transplantation in multiple myeloma.
abstract: Autologous stem cell transplantation (ASCT) has enabled the use of high-dose alkylating agents either as a single agent or in combination with other cytotoxic agents and/or total body irradiation (TBI) for the treatment of multiple myeloma. Despite improved complete remission rates, relapse and regimen-related toxicities remain challenging. In an effort to increase event-free survival and decrease the high incidence of regimen-related toxicity, we have studied the use of etoposide in combination with reduced-dose busulfan and cyclophosphamide as a conditioning regimen for ASCT in a group of 26 patients with advanced multiple myeloma. Median follow-up for the group was 30 months. There was no early treatment-related mortality. The main toxicity was mucositis. Otherwise, there was 1 case of reversible, clinically diagnosed hepatic veno-occlusive disease. Post-engraftment, 10 patients (38%) achieved CR, 15 (58%) patients achieved PR or SD, and 1 patient developed progressive disease (4%). Five patients in PR and 1 with progressive disease before transplant attained a CR post-transplant. The median times for event-free survival and overall survival after transplantation were 24 and 43 months, respectively. In conclusion, conditioning with busulfan, cyclophosphamide, and etoposide followed by ASCT is a safe regimen with comparable effectiveness to other previously used preparative regimens, thus providing another approach of non-TBI containing high-dose chemotherapy for patients with multiple myeloma.
authors.affiliation: University of Florida, Division of Hematology/Oncology, Gainesville, Florida 32610, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Cogle
authors.forename: Jan S
authors.initials: JS
authors.lastname: Moreb
authors.forename: Helen L
authors.initials: HL
authors.lastname: Leather
authors.forename: Katarzyna J
authors.initials: KJ
authors.lastname: Finiewicz
authors.forename: Shahab A
authors.initials: SA
authors.lastname: Khan
authors.forename: Vijay S
authors.initials: VS
authors.lastname: Reddy
authors.forename: John R
authors.initials: JR
authors.lastname: Wingard
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002066:Busulfan / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D009367:Neoplasm Staging; D010976:Platelet Count; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000009:adverse effects; D016019:Survival Analysis; D013997:Time Factors; D014182:Transplantation, Autologous; D014916:Whole-Body Irradiation
chemical_list: D005047:Etoposide; D003520:Cyclophosphamide; D002066:Busulfan