title: 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.
abstract: 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.
authors.affiliation: Bristol Haematology and Oncology Centre, Bristol, UK. jenny.bird@ubht.swest.nhs.uk
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Bird
authors.forename: Rhian
authors.initials: R
authors.lastname: Fuge
authors.forename: Bhawna
authors.initials: B
authors.lastname: Sirohi
authors.forename: Jane F
authors.initials: JF
authors.lastname: Apperley
authors.forename: Ann
authors.initials: A
authors.lastname: Hunter
authors.forename: John
authors.initials: J
authors.lastname: Snowden
authors.forename: Premini
authors.initials: P
authors.lastname: Mahendra
authors.forename: Donald
authors.initials: D
authors.lastname: Milligan
authors.forename: Jenny
authors.initials: J
authors.lastname: Byrne
authors.forename: Timothy
authors.initials: T
authors.lastname: Littlewood
authors.forename: Christopher
authors.initials: C
authors.lastname: Fegan
authors.forename: Grant
authors.initials: G
authors.lastname: McQuaker
authors.forename: Antonio
authors.initials: A
authors.lastname: Pagliuca
authors.forename: Peter
authors.initials: P
authors.lastname: Johnson
authors.forename: Amin
authors.initials: A
authors.lastname: Rahemtulla
authors.forename: Curly
authors.initials: C
authors.lastname: Morris
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
mesh_terms: 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