INTRODUCTION: Today, a number of therapeutic options are available as the patient with myeloma relapses from initial treatment with high-dose melphalan and autologous stem cell transplantation (ASCT). For patients who experience a durable response to primary ASCT, retreatment with high-dose melphalan is recommended by many current guidelines. Yet, toxicity is an important aspect in the choice of relapse treatment, and a second ASCT in this setting could be associated with enhanced toxicity. As the goal for the treatment for relapsed myeloma should be disease control while maintaining quality of life, lower doses of melphalan might be preferable. METHODS AND OBJECTIVES: In this retrospective study, we account for the outcome of 66 patients with myeloma in first systemic relapse after ASCT, who were treated with intermediate-dose melphalan, 100 mg/m2, and stem cell support (MEL 100). The aim was to evaluate this treatment in relation to prior response duration after initial ASCT and with respect to response rate, toxicity and survival. RESULTS: The overall response rate was 62%. There was limited, mostly haematological, toxicity, and no treatment-related mortality was observed. The median progression-free survival (PFS) was 8.5 months, and the median overall survival was 24 months. Patients with time to progression of 34 months or more (n=17; ≥75th percentile) after initial ASCT had a median PFS of 12.5 months after MEL 100. CONCLUSION: For patients with a long-lasting response after ASCT, MEL 100 could be a therapeutic option with low toxicity and with efficacy comparable to newer immunomodulatory drugs.
INTRODUCTION: Today, a number of therapeutic options are available as the patient with myeloma relapses from initial treatment with high-dose melphalan and autologous stem cell transplantation (ASCT). For patients who experience a durable response to primary ASCT, retreatment with high-dose melphalan is recommended by many current guidelines. Yet, toxicity is an important aspect in the choice of relapse treatment, and a second ASCT in this setting could be associated with enhanced toxicity. As the goal for the treatment for relapsed myeloma should be disease control while maintaining quality of life, lower doses of melphalan might be preferable. METHODS AND OBJECTIVES: In this retrospective study, we account for the outcome of 66 patients with myeloma in first systemic relapse after ASCT, who were treated with intermediate-dose melphalan, 100 mg/m2, and stem cell support (MEL 100). The aim was to evaluate this treatment in relation to prior response duration after initial ASCT and with respect to response rate, toxicity and survival. RESULTS: The overall response rate was 62%. There was limited, mostly haematological, toxicity, and no treatment-related mortality was observed. The median progression-free survival (PFS) was 8.5 months, and the median overall survival was 24 months. Patients with time to progression of 34 months or more (n=17; ≥75th percentile) after initial ASCT had a median PFS of 12.5 months after MEL 100. CONCLUSION: For patients with a long-lasting response after ASCT, MEL 100 could be a therapeutic option with low toxicity and with efficacy comparable to newer immunomodulatory drugs.
Authors: T-F Wang; M A Fiala; A F Cashen; G L Uy; C N Abboud; T Fletcher; N Wu; P Westervelt; J F DiPersio; K E Stockerl-Goldstein; R Vij Journal: Bone Marrow Transplant Date: 2014-07-28 Impact factor: 5.483
Authors: Wilson I Gonsalves; Francis K Buadi; Sikander Ailawadhi; P Leif Bergsagel; Asher A Chanan Khan; David Dingli; Angela Dispenzieri; Rafael Fonseca; Susan R Hayman; Prashant Kapoor; Taxiarchis V Kourelis; Martha Q Lacy; Jeremy T Larsen; Eli Muchtar; Craig B Reeder; Taimur Sher; A Keith Stewart; Rahma Warsame; Ronald S Go; Robert A Kyle; Nelson Leung; Yi Lin; John A Lust; Stephen J Russell; Stephen R Zeldenrust; Amie L Fonder; Yi L Hwa; Miriam A Hobbs; Angela A Mayo; William J Hogan; S Vincent Rajkumar; Shaji K Kumar; Morie A Gertz; Vivek Roy Journal: Bone Marrow Transplant Date: 2018-07-09 Impact factor: 5.483