EPOCH-F: a novel salvage regimen for multiple myeloma before reduced-intensity allogeneic hematopoietic SCT
| Autor: | S Jamshed, Jeanne Odom, D.H. Fowler, Kelly Bryant, F.T. Hakim, Sattva S. Neelapu, Seth M. Steinberg, Michael R. Bishop, Robert M. Dean |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
medicine.medical_specialty Transplantation Conditioning Gastroenterology Article Prednisone Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans Transplantation Homologous EPOCH (chemotherapy) Cyclophosphamide Multiple myeloma Etoposide Aged Salvage Therapy Transplantation Hematology business.industry Hematopoietic Stem Cell Transplantation Middle Aged medicine.disease Fludarabine Surgery Regimen Treatment Outcome Doxorubicin Vincristine Multiple Myeloma business Vidarabine medicine.drug |
| Zdroj: | Bone Marrow Transplantation. 46:676-681 |
| ISSN: | 1476-5365 0268-3369 |
| DOI: | 10.1038/bmt.2010.173 |
| Popis: | There exists a need for effective salvage regimens for multiple myeloma patients being considered for reduced-intensity allogeneic hematopoietic SCT (RI-alloHSCT). We developed EPOCH-F, a regimen consisting of infusional etoposide, VCR and adriamycin with prednisone, CY and fludarabine to achieve both tumor control and host lymphocyte depletion to facilitate engraftment before RI-alloHSCT. In all, 22 multiple myeloma patients were treated with EPOCH-F before RI-alloHSCT. The median age was 53 years (range 36–65), and the median number of previous therapies was 2 (range 1–8). Patients received a median of three cycles (range 1–5) of EPOCH-F. Toxicities were primarily hematologic and manageable. Median lymphocyte counts decreased from 1423/μL (range 335–2788) to 519/μL (range 102–1420; P = 0.0002). The overall response (⩾PR) to EPOCH-F was 22 with 13% achieving a CR/near-complete response (nCR); only 1 patient progressed while on therapy. A total of 20 patients underwent RI-alloHSCT. Median day + 100 donor chimerism was 100% (range 60–100). In all, 70% of patients achieved very good partial response or better response after transplant; 40% of patients achieved CR/nCR. TRM at 100 days and 5 years was 5 and 30%, respectively. Median OS after RI-alloHSCT was 46.1 months. EPOCH-F provides disease control and host lymphocyte depletion with consistent full donor engraftment in multiple myeloma patients undergoing RI-alloHSCT. |
| Databáze: | OpenAIRE |
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