The clinical outcome and toxicity of high-dose chemotherapy and autologous stem cell transplantation in patients with myeloma or amyloid and severe renal impairment: a British Society of Blood and Marrow Transplantation study.
The outcome of high-dose chemotherapy (HDT) was evaluated retrospectively in 27 patients with myeloma and four patients with AL amyloidosis with severe renal impairment. Twenty-three patients were receiving dialysis and the rest had a creatinine clearance of <20 ml/min. The median melphalan dose was 140 mg/m2 (range: 60-200 mg/m2), but 10 patients (37%) received 200 mg/m2. Myeloid and platelet engraftment were similar to that seen in patients without renal failure. Five of 27 patients died of transplant-related toxicity before the day 100. Twenty of 27 patients had a response (70%). The median time to disease progression was 32 months (range: 6-54 months) and the median time to best response was 6.5 months. Four of 17 evaluable patients (24%) became dialysis-independent at a median of 5 months post-HDT/stem cell transplantation. At a median follow-up of 70 months, 7/23 patients with myeloma were alive but three of these seven patients had progressive disease. Two of the four patients with amyloidosis have survived. HDT is feasible in these patients and results in 5-year survival in about one-third of patients.
Bird
Jennifer M
JM
Bristol Haematology and Oncology Centre, Bristol, UK. jenny.bird@ubht.swest.nhs.uk
Fuge
Rhian
R
Sirohi
Bhawna
B
Apperley
Jane F
JF
Hunter
Ann
A
Snowden
John
J
Mahendra
Premini
P
Milligan
Donald
D
Byrne
Jenny
J
Littlewood
Timothy
T
Fegan
Christopher
C
McQuaker
Grant
G
Pagliuca
Antonio
A
Johnson
Peter
P
Rahemtulla
Amin
A
Morris
Curly
C
Marks
David I
DI
D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000401:mortality / Q000628:therapy*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018450:Disease Progression; D004334:Drug Administration Schedule; D006801:Humans; D007674:Kidney Diseases / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality / Q000628:therapy*; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D033581:Stem Cell Transplantation / Q000009:adverse effects; D015996:Survival Rate; D014182:Transplantation, Autologous; D016896:Treatment Outcome