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Sequential, cycling maintenance therapy for post transplant multiple myeloma

Bone Marrow Transplantation volume 37, pages 89–94 (2006)Cite this article

Summary:

High-dose chemotherapy with autologous stem cell transplantation in patients with newly diagnosed multiple myeloma can prolong survival but is not curative. Maintenance therapy post transplant may prolong the disease-free interval and impact overall survival. We have conducted a phase II pilot study of 28 post transplant myeloma patients treated with a sequential, cycling maintenance regimen. The regimen was designed to include a variety of active myeloma agents chosen for ease of administration to enhance patient compliance and scheduled sequentially to minimize toxicity. The 12-month cycling schedule included dexamethasone (months 1–3); melphalan and prednisone (months 4, 5); cyclophosphamide and prednisone (months 6, 7); α-interferon (months 8–10); followed by a drug holiday (months 11, 12). The regimen was generally well tolerated with five patients developing reversible grade III–IV toxicity (diabetes-induced hyperglycemia in four, neutropenia in one). There was one toxic death on study due to non-neutropenic pneumonia and sepsis. Median event-free survival from transplant was 36.9 months (95% CI 23.6 – upper limit not yet reached) with median overall survival not yet reached at a median follow-up of 44 months. This concept of cycling, sequential maintenance with various agents, perhaps including newer biological, targeted agents, warrants further investigation in multiple myeloma.

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Authors and Affiliations

  1. Department of Haematology/Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada

    C I Chen, S Nanji, A Prabhu & R Beheshti

  2. Department of Biostatistics, Princess Margaret Hospital, Toronto, Ontario, Canada

    Q-L Yi

  3. University Health Network, Toronto General Hospital, Toronto, Ontario, Canada

    D Sutton

  4. McLaughlin Centre for Molecular Medicine, Toronto, Ontario, Canada

    A K Stewart

Authors
  1. C I Chen
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  2. S Nanji
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  7. A K Stewart
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Correspondence to C I Chen.

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Chen, C., Nanji, S., Prabhu, A. et al. Sequential, cycling maintenance therapy for post transplant multiple myeloma. Bone Marrow Transplant 37, 89–94 (2006). https://doi.org/10.1038/sj.bmt.1705206

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