title: Effect of melphalan 140 mg/m(2) vs 200 mg/m(2) on toxicities and outcomes in multiple myeloma patients undergoing single autologous stem cell transplantation-a single center experience.
abstract: Although melphalan at a dose of 140 mg/m(2) (MEL140) is an acceptable conditioning regimen for autologous stem cell transplantation (ASCT) in multiple myeloma (MM) patients, very few studies compared it to the most commonly used dose of 200 mg/m(2) (MEL200). A retrospective review of records of MM patients (2001-2010) identified 33 patients who received MEL140 and 96 patients who received MEL200. As expected, significantly higher percentage of patients in the MEL140 arm were >65 years or had cardiac ejection fraction <50%, had Karnofsky score <80, or had creatinine >2 at the time of ASCT (P≤.01). There were no significant differences in incidence of treatment related mortality and morbidity. At a median follow-up of 74 months from ASCT, there were no significant differences in relapse free survival (RFS) and overall survival (OS) between the two groups. Similar proportion had myeloma status improve to ≥VGPR at 3 months post-ASCT. Usage of post-ASCT maintenance was similar. In multivariate cox proportional hazards model, only disease status of ≥VGPR at the time of ASCT significantly improved RFS (P=.024), but not OS (P=.104). In conclusion, MM patients who received MEL140 had similar long-term outcomes to MEL200 patients despite their older age and co-morbidities.
authors.affiliation: Department of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Lakshmikanth
authors.initials: L
authors.lastname: Katragadda
authors.affiliation: Department of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: McCullough
authors.affiliation: Department of Biostatistics, University of Florida, Gainesville, FL, USA.
authors.forename: Yunfeng
authors.initials: Y
authors.lastname: Dai
authors.affiliation: Department of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Hsu
authors.affiliation: Department of Medicine, University of Vanderbilt, Nashville, TN, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Byrne
authors.affiliation: Department of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: John
authors.initials: J
authors.lastname: Hiemenz
authors.affiliation: Department of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Stratford
authors.initials: S
authors.lastname: May
authors.affiliation: Department of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Cogle
authors.affiliation: Department of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Maxim
authors.initials: M
authors.lastname: Norkin
authors.affiliation: Department of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Randy A
authors.initials: RA
authors.lastname: Brown
authors.affiliation: Department of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Wingard
authors.affiliation: Department of Biostatistics, University of Florida, Gainesville, FL, USA.
authors.forename: Myron
authors.initials: M
authors.lastname: Chang
authors.affiliation: Department of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Jan S
authors.initials: JS
authors.lastname: Moreb
mesh_terms: D000368:Aged; D004305:Dose-Response Relationship, Drug; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008558:Melphalan / Q000008:administration & dosage*; D009101:Multiple Myeloma / Q000601:surgery*; D019653:Myeloablative Agonists / Q000008:administration & dosage; D012189:Retrospective Studies; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D019653:Myeloablative Agonists; D008558:Melphalan
keywords: autologous stem cell transplantation; melphalan dose; multiple myeloma; outcomes; toxicities