title: Effect of time to infusion of autologous stem cells (24 vs. 48 h) after high-dose melphalan in patients with multiple myeloma.
abstract: High-dose melphalan (HD-Mel) is considered the current standard of care among the preparative regimens used in autologous peripheral blood stem cell transplantation (SCT) for multiple myeloma (MM), but optimal time and schedule of administration is not defined. We retrospectively analyzed outcomes and toxicities of HD-Mel administered on day -2 vs. day -1 before autologous stem cells infusion. A total of 138 consecutive MM patients treated at Penn State Hershey Cancer Institute between 2007 and 2010 were included in this study. No difference in time to hematopoietic recovery, common SCT-related toxicities, and clinical outcomes was seen between patients who received HD-Mel on day -2 (group A, n = 47), and those who received it on day -1 (group B, n = 91). Prompt and full hematopoietic recovery occurred even when stem cells were infused between 8 and 24 h after completion of chemotherapy. In the absence of prospective and randomized data, we conclude that a single I.V. infusion of HD-Mel on day -1 is a safe and effective practice, and the so-called 'day of rest' before the transplant appears not to be necessary.
authors.affiliation: Penn State Milton S. Hershey Cancer Institute, Hershey, PA 17033-0850, USA. gtalamo@hmc.psu.edu
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Talamo
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Rakszawski
authors.forename: Witold B
authors.initials: WB
authors.lastname: Rybka
authors.forename: Nathan G
authors.initials: NG
authors.lastname: Dolloff
authors.forename: Jozef
authors.initials: J
authors.lastname: Malysz
authors.forename: Tamara
authors.initials: T
authors.lastname: Berno
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zangari
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006412:Hematopoietic Stem Cells; D006801:Humans; D008297:Male; D008558:Melphalan / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality* / Q000628:therapy*; D019653:Myeloablative Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D036102:Peripheral Blood Stem Cell Transplantation; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014182:Transplantation, Autologous
chemical_list: D019653:Myeloablative Agonists; D008558:Melphalan