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Myeloma

Prolonged survival after intensive therapy and purged ABMT in patients with multiple myeloma

Bone Marrow Transplantation volume 26, pages 621–626 (2000)Cite this article

Abstract

Despite numerous strategies, the cure of multiple myeloma remains a difficult challenge. Recent approaches have involved dose-intensive therapy followed by stem cell transplantation, most often with autologous stem cells (ASCT). Although ASCT is of benefit, it is not considered curative. Between 1988 and 1995, we utilized an aggressive three-drug conditioning regimen followed by ABMT using marrow purged with either 4-hydroperoxycyclophosphamide (4-HC) or mafosphamide (MAF). Twenty-nine of 42 patients who had first received VAD (14 patients) or VAD followed by cyclophosphamide (7 g/m2i.v.) + dexamethasone (40 mg/day p.o. ×4) + GM-CSF (15 patients) met the eligibility criteria needed to undergo bone marrow harvest and ABMT, ie ⩽10% marrow plasma cells and ⩾50% decrease in paraprotein level. Alpha-interferon maintenance therapy was given post ABMT. Median follow-up is 7.5 years (range 5.0–11.25). Six early and two late non-relapse deaths occurred; 15 patients have relapsed. Seven patients remain in continuous CR (five) or PR (two), including three with stage IIIB disease at diagnosis. One patient developed a soft tissue sarcoma 8 years post ASCT. Although this protocol produced excessive toxicity compared with current approaches, the results demonstrate that dose-intensive therapy and ASCT can produce durable remission in this disease. Further development of dose-intensive strategies is warranted. Bone Marrow Transplantation (2000) 26, 621–626.

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Acknowledgements

We would like to thank Trudy Winkle and Brenda Bailey for assistance in the preparation of this manuscript.

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Authors and Affiliations

  1. University of Kentucky Blood and Marrow Transplant Program, Lexington, KY, USA

    DE Reece & GL Phillips

  2. Leukemia/BMT Program of British Columbia, Vancouver General Hospital and University of British Columbia, British Columbia Cancer Agency, Vancouver, BC, Canada

    DA Brockington, MJ Barnett, H-G Klingemann, SH Nantel, HJ Sutherland & JD Shepherd

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Reece, D., Brockington, D., Phillips, G. et al. Prolonged survival after intensive therapy and purged ABMT in patients with multiple myeloma. Bone Marrow Transplant 26, 621–626 (2000). https://doi.org/10.1038/sj.bmt.1702574

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