High-dose therapy followed by autologous hematopoietic stem-cell infusion for patients with multiple myeloma
| Autor: | Peter A. McSweeney, Kathy Schiffman, Thomas R. Chauncey, J Klarnet, David G. Maloney, C H Weaver, T Barnett, R. T. Maziarz, Reginald A. Clift, Scott D. Rowley, K Lilleby, FR Appelbaum, Buckner Cd, William I. Bensinger, Rainer Storb, A Fefer, Taner Demirer, Leona Holmberg |
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| Rok vydání: | 1996 |
| Předmět: |
Adult
Male Melphalan Cancer Research medicine.medical_specialty Cyclophosphamide medicine.medical_treatment Urology Antineoplastic Agents ThioTEPA Cause of Death Immunopathology Outcome Assessment Health Care medicine Humans Busulfan Multiple myeloma Aged Bone Marrow Transplantation Chemotherapy business.industry Hematopoietic Stem Cell Transplantation Interferon-alpha Middle Aged medicine.disease Combined Modality Therapy Survival Analysis Surgery Radiation therapy Oncology Female Multiple Myeloma business medicine.drug |
| Zdroj: | Journal of Clinical Oncology. 14:1447-1456 |
| ISSN: | 1527-7755 0732-183X |
| Popis: | PURPOSE To evaluate the outcome of patients with multiple myeloma (MM) who received high-dose therapy followed by autologous bone marrow (BM) or peripheral-blood stem-cell (PBSC) infusion. PATIENTS AND METHODS Sixty-three consecutive patients with MM received autologous BM (n = 13) or PBSC with or without BM (n = 50) following regimens that contained busulfan (Bu) and cyclophosphamide (Cy) (n = 18), modified total-body irradiation (TBI) followed by Bu and Cy (n = 36), or Bu, melphalan, and thiotepa (n = 9). Two thirds of the patients had resistant disease and 69% had received more than 6 months of previous chemotherapy. RESULTS AND CONCLUSION Recovery of peripheral-blood cell counts was more rapid in patients who received PBSC with or without BM than in patients who received BM alone. Sixteen of 63 patients (25%) died of complications of treatment within 100 days. Nineteen (40%) of 48 assessable patients achieved a complete response (CR), 23 (48%) had a partial response (PR), and six (12%) had no response. The probabilities of survival and survival without relapse or progression for all 63 patients at 3.0 years were .43 and .21, respectively. The probability of relapse or progression at 3 years was .69, and 17 patients (27%) have died of progressive MM. The probabilities of survival and relapse-free survival at 3 years for the 19 patients who achieved a CR were .42 and .17, respectively. In the multivariate analysis, beta2-microglobulin levels more than 2.5 micrograms/mL, more than two regimens of prior therapy and eight cycles of treatment, time to transplant longer than 3 years from diagnosis, and prior radiation were associated with adverse outcomes. Additional strategies, such as intervention earlier in the disease course, improved treatment regimens, sequential high-dose treatments, and posttransplant therapies may improve outcome of selected patients with MM. |
| Databáze: | OpenAIRE |
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