Melphalan versus melphalan plus busulphan in conditioning to autologous stem cell transplantation for low-risk multiple myeloma.
BACKGROUND
High-dose chemotherapy conditioning regimens for autologous stem cell transplantation generally give similar results in multiple myeloma. We compared two regimens: melphalan versus melphalan plus busulphan.


METHODS
In all, 30 untreated patients with stage III low-risk multiple myeloma were studied. After induction with three VAD courses and mobilization with cyclophosphamide 7 g/m(2) and recombinant human granulocyte-colony stimulating factor (rHuG-CSF) (10 microg/kg b.w./die), they received melphalan 200 mg/m(2) (arm A) or busulphan 16 mg/kg plus melphalan 100 mg/m(2) (arm B) for conditioning for transplantation. All patients received maintenance therapy with Interferon 3 MU x 3/week.


RESULTS
Time to engraftment after transplantation was similar in both groups. All patients received rHuG-CSF after reinfusion of peripheral stem cells. No differences emerged in transplant-related infective and noninfective complications. There were no transplant-related deaths. A better response was observed in the melphalan plus busulphan regimen (85 versus 75%, P<0.05). The 5-year overall survival with this regimen was 56 versus 49% with melphalan, and the median survival was 126 months versus 108 months for melphalan (P=0.7). The median progression-free survival was 121 months for melphalan plus busulphan versus 97 months for melphalan (P=0.05).


CONCLUSIONS
These two conditioning regimens showed similar overall response rate and overall survival, though progression-free survival was better with busulphan plus melphalan.
Ria
Roberto
R
Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari, Bari, Italy.
Falzetti
Franca
F
Ballanti
Stelvio
S
Minelli
Olivia
O
Di Ianni
Mauro
M
Cimminiello
Michele
M
Vacca
Angelo
A
Dammacco
Franco
F
Martelli
Massimo F
MF
Tabilio
Antonio
A
D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D002066:Busulfan / Q000008:administration & dosage*; D005260:Female; D006085:Graft Survival; D006801:Humans; D008297:Male; D008558:Melphalan / Q000008:administration & dosage*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy*; D033581:Stem Cell Transplantation; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods; D014182:Transplantation, Autologous
D018906:Antineoplastic Agents, Alkylating; D002066:Busulfan; D008558:Melphalan