title: Melphalan 100 mg/m2 with stem cell support as first relapse treatment is safe and effective for myeloma patients with long remission after autologous stem cell transplantation.
abstract: BACKGROUND
  Today, a number of therapeutic options are available as the patient with myeloma relapses from initial treatment with high-dose melphalan and autologous stem cell transplantation (ASCT). For patients who experience a durable response to primary ASCT, retreatment with high-dose melphalan is recommended by many current guidelines. Yet, toxicity is an important aspect in the choice of relapse treatment, and a second ASCT in this setting could be associated with enhanced toxicity. As the goal for the treatment for relapsed myeloma should be disease control while maintaining quality of life, lower doses of melphalan might be preferable.
  
  
  OBJECTIVE
  In this retrospective study, we account for the outcome of 66 patients with myeloma in first systemic relapse after ASCT, who were treated with intermediate-dose melphalan, 100 mg/m2, and stem cell support (MEL 100). The aim was to evaluate this treatment in relation to prior response duration after initial ASCT and with respect to response rate, toxicity and survival.
  
  
  RESULTS
  The overall response rate was 62%. There was limited, mostly haematological, toxicity, and no treatment-related mortality was observed. The median progression-free survival (PFS) was 8.5 months, and the median overall survival was 24 months. Patients with time to progression of 34 months or more (n=17; ≥75th percentile) after initial ASCT had a median PFS of 12.5 months after MEL 100.
  
  
  CONCLUSIONS
  For patients with a long-lasting response after ASCT, MEL 100 could be a therapeutic option with low toxicity and with efficacy comparable to newer immunomodulatory drugs.
authors.affiliation: Section of Hematology and Coagulation, Department of Internal Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden. cecilie.blimark@vgregion.se
authors.forename: Cecilie
authors.initials: C
authors.lastname: Blimark
authors.forename: Ljupco
authors.initials: L
authors.lastname: Veskovski
authors.forename: Jan
authors.initials: J
authors.lastname: Westin
authors.forename: Stig
authors.initials: S
authors.lastname: Rödjer
authors.forename: Mats
authors.initials: M
authors.lastname: Brune
authors.forename: Martin
authors.initials: M
authors.lastname: Hjorth
authors.forename: Erik
authors.initials: E
authors.lastname: Holmberg
authors.forename: Per-Ola
authors.initials: PO
authors.lastname: Andersson
authors.forename: Ulf-Henrik
authors.initials: UH
authors.lastname: Mellqvist
mesh_terms: D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage* / Q000009:adverse effects; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008558:Melphalan / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan