title: Re-use of the original infusional induction chemotherapy as salvage therapy in myeloma patients relapsing after one autograft.
abstract: If standard infusional therapy (IC) has been used to treat myeloma at presentation, it is a matter of debate whether patients should receive the original induction therapy or a different drug combination in first relapse. Instinctively, most clinicians may switch treatment, particularly since the advent of new drugs for the treatment of myeloma. Hitherto, there has been no data on the efficacy of repeating standard IC in the salvage setting. We studied 62 myeloma patients whose initial treatment consisted of C-VAMP and a single high dose melphalan procedure and who were retreated with C-VAMP at the time of first relapse. Response to salvage C-VAMP was seen in 50% (95% confidence interval = 0.37-0.62) but we were unable to identify any predictors for response to salvage C-VAMP. Only patients resistant to salvage C-VAMP benefited from a second autograft. The survival of patients who responded to salvage C-VAMP was not prolonged by a second transplant. In conclusion, our data supports the use of C-VAMP for patients with myeloma in first relapse and suggest that only patients resistant to salvage C-VAMP should be offered a second autograft.
authors.affiliation: Leukaemia Unit, Royal Marsden NHS Trust, Surrey, UK.
authors.forename: Bhawna
authors.initials: B
authors.lastname: Sirohi
authors.forename: Ray
authors.initials: R
authors.lastname: Powles
authors.forename: Claudius
authors.initials: C
authors.lastname: Rudin
authors.forename: Seema
authors.initials: S
authors.lastname: Singhal
authors.forename: Samar
authors.initials: S
authors.lastname: Kulkarni
authors.forename: Radovan
authors.initials: R
authors.lastname: Saso
authors.forename: Clive
authors.initials: C
authors.lastname: Horton
authors.forename: Jayesh
authors.initials: J
authors.lastname: Mehta
authors.forename: Jennifer
authors.initials: J
authors.lastname: Treleaven
mesh_terms: D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008558:Melphalan / Q000008:administration & dosage*; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D014182:Transplantation, Autologous; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D018906:Antineoplastic Agents, Alkylating; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D008558:Melphalan; D008775:Methylprednisolone