title: Etoposide, methylprednisolone, cytarabine and cisplatin successfully cytoreduces resistant myeloma patients and mobilizes them for transplant without adverse effects.
abstract: Myeloma remains incurable with a median survival of 4 years, but outcome can be improved by the use of high-dose therapy. We used the etoposide, methylprednisolone, cytarabine and cisplatin (ESHAP) regimen as second-line therapy in 42 newly diagnosed myeloma patients who had failed vincristine, adriamycin and dexamethasone (VAD)- type therapy (n = 36), responded to first-line treatment but persisted in having significant residual marrow plasmacytosis (n = 5) or failed prior stem cell harvesting (n = 1), with the dual aim of improving disease response and mobilizing peripheral blood stem cells. Fourteen of 21 (67%) patients with no change or progressive disease after VAD responded to ESHAP; seven of 12 (58%) patients with minor response converted to partial response. Marrow plasmacytosis fell from a median of 52% at diagnosis to 23.5% after primary therapy and to15% after ESHAP. ESHAP chemotherapy was well-tolerated. There were 11 admissions due to febrile neutropenia (n = 7), nausea and vomiting (n = 2), pneumonia (n = 1) and perforated bowel (n = 1). Renal function deteriorated in 13 of 42 patients after ESHAP, but none required renal support. ESHAP mobilization was performed in 32 patients of whom 87% achieved a CD34(+) yield >2 x 10(6)/kg. In all, 38 patients proceeded to high-dose therapy. The overall survival for all patients was 62% at 4 years following ESHAP. We conclude that ESHAP has acceptable toxicity and efficient stem cell mobilizing capability, effectively cytoreduced this chemoresistant group of patients, and did not appear to adversely affect transplant outcome.
authors.affiliation: Department of Haematology, University College London Hospitals NHS Trust, London, UK. shirley.dsa@uclh.nhs.uk
authors.forename: Shirley
authors.initials: S
authors.lastname: D'Sa
authors.forename: Kwee
authors.initials: K
authors.lastname: Yong
authors.forename: Chara
authors.initials: C
authors.lastname: Kyriakou
authors.forename: Soumo
authors.initials: S
authors.lastname: Bhattacharya
authors.forename: Karl S
authors.initials: KS
authors.lastname: Peggs
authors.forename: Barbara
authors.initials: B
authors.lastname: Foulkes
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Watts
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Ings
authors.forename: Kirit M
authors.initials: KM
authors.lastname: Ardeshna
authors.forename: Anthony H
authors.initials: AH
authors.lastname: Goldstone
authors.forename: Catherine D
authors.initials: CD
authors.lastname: Williams
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002452:Cell Count; D002945:Cisplatin / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy; D010950:Plasma Cells / Q000473:pathology
chemical_list: D003561:Cytarabine; D005047:Etoposide; D002945:Cisplatin; D008775:Methylprednisolone