Reduced intensity conditioning with thiotepa, fludarabine, and melphalan is effective in advanced multiple myeloma.
Fifty-three patients with multiple myeloma (MM) underwent an allogeneic stem cell transplant (HSCT) from their HLA identical siblings using a reduced-intensity conditioning consisting of thioteopa 5 mg/kg, fludarabine 90 mg/m(2), and melphalan 80 mg/m(2). Their median age was 52 years (range 38 - 68) and the interval from diagnosis 12 months. Forty-three patients (82%) had advanced disease and 33 had previously been treated with high-dose therapy with one (N = 21), or more (N = 12) autologus transplants. Ten (18%) had their allograft programmed after induction chemotherapy. The majority (N = 44) received peripheral blood as stem cell source. Acute graft-versus-host disease (GVHD) grade II - IV developed in 45%, but grade III - IV in only 5%. Cumulative incidence of chronic GVHD was 64%. Sixty-two per cent were in complete remission (CR) following transplantation. Transplant-related mortality was 13%. Relapse incidence was 32%. With a median follow-up of 22 months, 3-year overall survival is 45% and progression free survival (PFS) 37%. The thiotepa, fludarabine, and melphalan conditioning regimen can produce remissions in the majority of MM patients with a limited transplant mortality rate. When used as first line treatment the results of transplantation appear even more encouraging.
Majolino
Ignazio
I
Hematology and Bone Marrow Transplantation Unit, Azienda Ospedaliera S. Camillo-Forlanini, Rome, Italy. imajolino@scamilloforlanini.rm.it
Davoli
Marina
M
Carnevalli
Ellen
E
Locasciulli
Anna
A
Di Bartolomeo
Paolo
P
Scimè
Rosanna
R
Corradini
Paolo
P
Selleri
Carmine
C
Narni
Franco
F
Musso
Maurizio
M
Bregni
Marco
M
Olivieri
Attilio
A
De Fabritiis
Paolo
P
Pogliani
Luigi
L
Arbelaez
Jorge E Duque
JE
Ruscio
Carla
C
Bacigalupo
Andrea
A
D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008558:Melphalan / Q000008:administration & dosage*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D019653:Myeloablative Agonists / Q000008:administration & dosage*; D033581:Stem Cell Transplantation / Q000379:methods*; D013852:Thiotepa / Q000008:administration & dosage*; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives*
D019653:Myeloablative Agonists; D013852:Thiotepa; D014740:Vidarabine; C024352:fludarabine; D008558:Melphalan