Three-step high-dose sequential chemotherapy in patients with newly diagnosed multiple myeloma

被引:4
作者
Ballestrero, A
Ferrando, F
Miglino, M
Clavio, M
Gonella, R
Garuti, A
Grasso, R
Ghio, R
Balleari, E
Gobbi, M
Patrone, F
机构
[1] Univ Genoa, Dept Internal Med, I-16132 Genoa, Italy
[2] Azienda Ospedaliera, Osped San Martino, Dept Hematol & Oncol, Genoa, Italy
[3] Clin Univ Convenzionate, Genoa, Italy
关键词
multiple myeloma; high-dose chemotherapy; peripheral blood progenitor cell; autologous transplantation;
D O I
10.1034/j.1600-0609.2002.01572.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background and objectives: High-dose chemotherapy (HDT) with autologous peripheral blood progenitor cell (PBPC) transplant has been increasingly used for newly diagnosed multiple myeloma (MM) in recent years. Presently available results suggest an improvement in the complete remission rate and survival as compared to conventional chemotherapy. However, there is no plateau in the survival curves, and experiments with new treatment schedules and conditioning regimens are warranted. Design and methods: In a non-randomised controlled trial, 20 patients underwent three-step HDT following conventional vineristine/doxo ulicin/dexamethasone (VAD)-based induction. In the intensification phase patients received high-dose cyclophosphamide (HD-CY), high-dose etoposide (HD-VP), and mitoxantrone (NOV) plus melphalan (L-PAM) with haemopoietic rescue. Maintenance treatment with interferon was given until relapse. Actuarial overall survival (OS) and event-free survival (EFS) curves were plotted according to the method of Kaplan and Meier. In five of the eight patients achieving complete remission (CR), the molecular disease was monitored by polymerase chain reaction technique (PCR). Results: Overall 18/20 (90%) patients responded, with a CR rate of 40%. After an average follow-Lip of 40 months, median EFS and OS are 25.5 and 44.6 months, respectively. Monoclonal cells were detectable in the. post-treatment bone marrow and in the aphereses of the five CR patients monitored by PCR. Conclusion: The present three-step HDT regimen, including conditioning with mitoxantrone and melphalan, proved to be feasible and safe. Our results are in agreement with the hypothesis that HDT results in an increased remission rate and in prolonged survival in newly diagnosed MM, but a cure is unlikely.
引用
收藏
页码:101 / 106
页数:6
相关论文
共 24 条
[1]  
ALLEN RC, 1992, AM J HUM GENET, V51, P1229
[2]  
ANDERSON KC, 2001, 5 C EUR HAEM ASS BIR, P42
[3]  
Attal M, 1999, BLOOD, V94, p714A
[4]   A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma [J].
Attal, M ;
Harousseau, JL ;
Stoppa, AM ;
Sotto, JJ ;
Fuzibet, JG ;
Rossi, JF ;
Casassus, P ;
Maisonneuve, H ;
Facon, T ;
Ifrah, N ;
Payen, C ;
Bataille, R .
NEW ENGLAND JOURNAL OF MEDICINE, 1996, 335 (02) :91-97
[5]   High-dose chemotherapy with tandem autologous transplantation as part of the initial therapy for aggressive non-Hodgkin's lymphoma [J].
Ballestrero, A ;
Clavio, M ;
Ferrando, F ;
Gonella, R ;
Garuti, A ;
Sessarego, M ;
Ghio, R ;
Gobbi, M ;
Patrone, F .
INTERNATIONAL JOURNAL OF ONCOLOGY, 2000, 17 (05) :1007-1013
[6]   High-dose mitoxantrone with peripheral blood progenitor cell rescue: toxicity, pharmacokinetics and implications for dosage and schedule [J].
Ballestrero, A ;
Ferrando, F ;
Garuti, A ;
Basta, P ;
Gonella, R ;
Esposito, M ;
Vannozzi, MO ;
Sorice, G ;
Friedman, D ;
Puglisi, M ;
Brema, F ;
Mela, GS ;
Sessarego, M ;
Patrone, F .
BRITISH JOURNAL OF CANCER, 1997, 76 (06) :797-804
[7]   Total therapy with tandem transplants for newly diagnosed multiple myeloma [J].
Barlogie, B ;
Jagannath, S ;
Desikan, KR ;
Mattox, S ;
Vesole, D ;
Siegel, D ;
Tricot, G ;
Munshi, N ;
Fassas, A ;
Singhal, S ;
Mehta, J ;
Anaissie, E ;
Dhodapkar, D ;
Naucke, S ;
Cromer, J ;
Sawyer, J ;
Epstein, J ;
Spoon, D ;
Ayers, D ;
Cheson, B ;
Crowley, J .
BLOOD, 1999, 93 (01) :55-65
[8]   EFFECTIVE TREATMENT OF ADVANCED MULTIPLE-MYELOMA REFRACTORY TO ALKYLATING-AGENTS [J].
BARLOGIE, B ;
SMITH, L ;
ALEXANIAN, R .
NEW ENGLAND JOURNAL OF MEDICINE, 1984, 310 (21) :1353-1356
[9]   HIGH-DOSE MELPHALAN AND AUTOLOGOUS BONE-MARROW TRANSPLANTATION AS CONSOLIDATION IN PREVIOUSLY UNTREATED MYELOMA [J].
CUNNINGHAM, D ;
PAZARES, L ;
MILAN, S ;
POWLES, R ;
NICOLSON, M ;
HICKISH, T ;
SELBY, P ;
TRELEAVAN, J ;
VINER, C ;
MALPAS, J ;
SLEVIN, M ;
FINDLAY, M ;
RAYMOND, J ;
GORE, ME .
JOURNAL OF CLINICAL ONCOLOGY, 1994, 12 (04) :759-763
[10]   CYCLOPHOSPHAMIDE AND ETOPOSIDE THERAPY WITH GM-CSF FOR VAD-RESISTANT MULTIPLE-MYELOMA [J].
DIMOPOULOS, MA ;
DELASALLE, KB ;
CHAMPLIN, R ;
ALEXANIAN, R .
BRITISH JOURNAL OF HAEMATOLOGY, 1993, 83 (02) :240-244