title: Autologous stem cell transplantation followed by consolidation chemotherapy for patients with multiple myeloma.
abstract: Although high-dose therapy and autologous stem cell transplant (ASCT) is superior to conventional chemotherapy for treatment of myeloma, most patients relapse and the time to relapse depends upon the initial prognostic factors. The administration of non-cross-resistant chemotherapies during the post-transplant period may delay or prevent relapse. We prospectively studied the role of consolidation chemotherapy (CC) after single autologous peripheral blood stem cell transplant (auto-PBSCT) in 103 mostly newly diagnosed myeloma patients (67 patients were < or =6 months from the initial treatment). Patients received conditioning with BCNU, melphalan+/-gemcitabine and auto-PBSCT followed by two cycles of the DCEP+/-G regimen (dexamethasone, cyclophosphamide, etoposide, cisplatin+/-gemcitabine) at 3 and 9 months post-transplant and alternating with two cycles of DPP regimen (dexamethasone, cisplatin, paclitaxel) at 6 and 12 months post-transplant. With a median follow-up of 61.2 months, the median event-free survival (EFS) and overall survival (OS) are 26 and 54.1 months, respectively. The 5-year EFS and OS are 23.1 and 42.5%, respectively. Overall, 51 (49.5%) patients finished all CC, suggesting that a major limitation of this approach is an inability to deliver all planned treatments. In order to improve results following autotransplantation, novel agents or immunologic approaches should be studied in the post-transplant setting.
authors.affiliation: Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA. igojo@umm.edu
authors.forename: I
authors.initials: I
authors.lastname: Gojo
authors.forename: B
authors.initials: B
authors.lastname: Meisenberg
authors.forename: C
authors.initials: C
authors.lastname: Guo
authors.forename: A
authors.initials: A
authors.lastname: Fassas
authors.forename: A
authors.initials: A
authors.lastname: Murthy
authors.forename: R
authors.initials: R
authors.lastname: Fenton
authors.forename: N
authors.initials: N
authors.lastname: Takebe
authors.forename: M
authors.initials: M
authors.lastname: Heyman
authors.forename: G L
authors.initials: GL
authors.lastname: Philips
authors.forename: M
authors.initials: M
authors.lastname: Cottler-Fox
authors.forename: C
authors.initials: C
authors.lastname: Sarkodee-Adoo
authors.forename: K
authors.initials: K
authors.lastname: Ruehle
authors.forename: T
authors.initials: T
authors.lastname: French
authors.forename: M
authors.initials: M
authors.lastname: Tan
authors.forename: G
authors.initials: G
authors.lastname: Tricot
authors.forename: A P
authors.initials: AP
authors.lastname: Rapoport
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002945:Cisplatin; D003131:Combined Modality Therapy / Q000379:methods; D003520:Cyclophosphamide; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D003907:Dexamethasone; D018572:Disease-Free Survival; D005047:Etoposide; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality / Q000628:therapy*; D019653:Myeloablative Agonists / Q000008:administration & dosage; D036102:Peripheral Blood Stem Cell Transplantation; D011446:Prospective Studies; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D000093542:Gemcitabine
chemical_list: D007166:Immunosuppressive Agents; D019653:Myeloablative Agonists; D003841:Deoxycytidine; D005047:Etoposide; D003907:Dexamethasone; D003520:Cyclophosphamide; D002945:Cisplatin; D008558:Melphalan; D000093542:Gemcitabine