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Myeloma

Acute lymphoblastic leukaemia-type intensive chemotherapy to eliminate minimal residual disease after high-dose melphalan and autologous transplantation in multiple myeloma – a phase I/II feasibility and tolerance study of 17 patients

Bone Marrow Transplantation volume 25, pages 949–956 (2000)Cite this article

Abstract

Aiming to target the minimal residual disease in patients with multiple myeloma, a phase I/II single centre study was undertaken for feasibility and tolerance of intensive acute lymphoblastic leukaemia consolidation chemotherapy (ALL-IC) as part of a strategy for post-transplant consolidation targeted at pre-B cells. Seventeen newly diagnosed patients with myeloma (median age 55 years; 30–65) were initially treated with courses of infused cyclophosphamide, vincristine, adriamycin and methylprednisolone (C-VAMP) followed by melphalan 200 mg/m2(HDM) and peripheral blood stem cell rescue (PBSC). Forty-seven percent were in CR and the rest in PR after HDM. ALL-IC consisted of vincristine, daunorubicin, etoposide, cytarabine, 6-thioguanine and prednisolone given over 5 days. All patients became neutropenic (<0.5 × 109/l) at a median of 10 days (4–18) and one of the 17 patients (5.8%) died 15 days post ALL-IC of sepsis. A further four have died of relapse with an overall survival (OS) of 67% at 4 years. Two of nine patients in PR at the time of ALL-IC achieved CR. Matched-pair analysis of 34 control patients shows no difference for OS and event-free survival between ALL-IC and controls. We conclude that ALL-IC given to myeloma patients after HDM/PBSC is as safe as when used in ALL and warrants further assessment in randomised trials for myeloma. Bone Marrow Transplantation (2000) 25, 949–956.

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Acknowledgements

This work was supported by Bud Flanagan Leukaemia Fund, Cancer Research Campaign, David Adams Leukaemia Fund.

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Author notes

  1. N Raje & S Singhal

    Present address: Dana Faber Cancer Institute, Boston, MA, USA

  2. J Mehta

    Present address: South Carolina Cancer Center and Richland Memorial Hospital, Columbia, South Carolina, USA

Authors and Affiliations

  1. Leukaemia and Myeloma Units, Royal Marsden NHS Trust and Institute of Cancer Research, Sutton, UK

    R Powles, B Sirohi, S Kulkarni, N Bhagwati, R Saso, N Raje, C Horton, S Singhal, J Mehta & J Treleaven

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Powles, R., Sirohi, B., Kulkarni, S. et al. Acute lymphoblastic leukaemia-type intensive chemotherapy to eliminate minimal residual disease after high-dose melphalan and autologous transplantation in multiple myeloma – a phase I/II feasibility and tolerance study of 17 patients. Bone Marrow Transplant 25, 949–956 (2000). https://doi.org/10.1038/sj.bmt.1702379

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