title: Intermediate-dose melphalan (100 mg/m2)/bortezomib/thalidomide/dexamethasone and stem cell support in patients with refractory or relapsed myeloma.
abstract: BACKGROUND
  Bortezomib and thalidomide have shown synergy with melphalan and dexamethasone. We used this 4-drug combination as conditioning before autologous hematopoietic cell infusions.
  
  
  METHODS
  Twenty-six patients with advanced-stage myeloma were treated with melphalan 50 mg/m(2) and bortezomib 1.3 mg/m(2) on days -6 and -3 in association with thalidomide 200 mg and dexamethasone 20 mg on days -6 through -3, followed by hematopoietic cell support on day 0.
  
  
  RESULTS
  Nonhematologic toxicities included pneumonia, febrile neutropenia, and peripheral neuropathy. All patients had undergone autologous transplantation at diagnosis, and 13 patients (50%) underwent an additional transplantation at relapse. Responses occurred in 17 of 26 patients (65%), including 1 complete remission, 3 near complete remissions (12%), and 2 very good partial remissions (8%). Response rate was higher than that induced by the previous line of treatment in 12 patients (46%).
  
  
  CONCLUSIONS
  Melphalan/bortezomib/thalidomide/dexamethasone showed encouraging antimyeloma activity in patients with advanced-stage myeloma.
authors.affiliation: Divisione di Ematologia dell'Universita di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Italy. appalumbo@yahoo.com
authors.forename: Antonio
authors.initials: A
authors.lastname: Palumbo
authors.forename: Ilaria
authors.initials: I
authors.lastname: Avonto
authors.forename: Benedetto
authors.initials: B
authors.lastname: Bruno
authors.forename: Antonietta
authors.initials: A
authors.lastname: Falcone
authors.forename: Potito Rosario
authors.initials: PR
authors.lastname: Scalzulli
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Ambrosini
authors.forename: Sara
authors.initials: S
authors.lastname: Bringhen
authors.forename: Francesca
authors.initials: F
authors.lastname: Gay
authors.forename: Cecilia
authors.initials: C
authors.lastname: Rus
authors.forename: Federica
authors.initials: F
authors.lastname: Cavallo
authors.forename: Patrizia
authors.initials: P
authors.lastname: Falco
authors.forename: Massimo
authors.initials: M
authors.lastname: Massaia
authors.forename: Pellegrino
authors.initials: P
authors.lastname: Musto
authors.forename: Mario
authors.initials: M
authors.lastname: Boccadoro
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001897:Boronic Acids / Q000008:administration & dosage; D000069286:Bortezomib; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D009101:Multiple Myeloma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011719:Pyrazines / Q000008:administration & dosage; D012008:Recurrence; D016879:Salvage Therapy; D016019:Survival Analysis; D013792:Thalidomide / Q000008:administration & dosage
chemical_list: D001897:Boronic Acids; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D003907:Dexamethasone; D008558:Melphalan