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Autografting

Tandem chemo-mobilization followed by high-dose melphalan and carmustine with single autologous hematopoietic cell transplantation for multiple myeloma

Bone Marrow Transplantation volume 47, pages 516–521 (2012)Cite this article

Abstract

Single autologous hematopoietic cell transplant (AHCT) with high-dose melphalan prolongs survival in patients with multiple myeloma but is not curative. We conducted a study of intensive single AHCT using tandem chemo-mobilization with CY and etoposide followed by high-dose conditioning with melphalan 200 mg/m2 plus carmustine 15 mg/kg. One hundred and eighteen patients in first consolidation (CON1) and 58 patients in relapse (REL) were transplanted using this intensified approach. Disease response improved from 32% very good PR (VGPR)+CR pre-mobilization to 76% VGPR+CR post transplant in CON1. With a median follow-up of 4.7 years, the median EFS was 2.8 years, and the median OS was 5.1 years in CON1. OS from time of transplant was significantly shorter for REL (3.4 years) compared with CON1 (5.1 years; P=0.02). However, OS from time of diagnosis was similar in REL (6.1 years) and CON1 (6.0 years; P=0.80). The 100-day non-relapse mortality in the CON1 and REL groups was 0% and 7%, respectively. In summary, intensified single AHCT with tandem chemo-mobilization and augmented high-dose therapy is feasible in multiple myeloma and leads to high-quality response rates.

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Author notes

  1. G G Laport and K Stockerl-Goldstein: These authors contributed equally to this work.

Authors and Affiliations

  1. Center for Hematologic Malignancies, Oregon Health & Science University, Portland, OR, USA

    A I Chen

  2. Division of Blood and Marrow Transplantation, Stanford University School of Medicine, Palo Alto, CA, USA

    R S Negrin, J A Shizuru, L J Johnston, R Lowsky, D B Miklos, S Arai, W-K Weng & G G Laport

  3. Department of Health, Research, and Policy—Statistics, Stanford University, Palo Alto, CA, USA

    A McMillan

  4. Division of Oncology, Washington University School of Medicine, St Louis, MO, USA

    K Stockerl-Goldstein

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  1. A I Chen
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  2. R S Negrin
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  10. G G Laport
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Correspondence to A I Chen.

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Chen, A., Negrin, R., McMillan, A. et al. Tandem chemo-mobilization followed by high-dose melphalan and carmustine with single autologous hematopoietic cell transplantation for multiple myeloma. Bone Marrow Transplant 47, 516–521 (2012). https://doi.org/10.1038/bmt.2011.106

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