High‐dose chemoradiotherapy with syngeneic bone marrow transplantation for multiple myeloma: A case report and literature review

Abstract

We had the opportunity to treat a patient with progressive heavily pretreated multiple myeloma with high-dose chemoradiotherapy with hematopoietic rescue by syngeneic bone marrow transplantation. The patient was a 53-year-old male who had previously received melphalan, prednisone, 1,3-bis (2-chloroethyl)-l-nitrosourea (BCNU), vincristine, and standard radiation therapy. At the time of bone marrow transplantation, he had increasing bone pain, increasing M-protein (IgG kappa), and a bone marrow diagnostic of myeloma. The transplant regimen consisted of cyclophosphamide, 60 mg/kg intravenously for 2 days, and total body irradiation--1,200 rads given as 200-rad fractions, twice daily for three days. The transplant course was complicated by confusion, herpes simplex mucositis, fever, and two episodes of idiopathic diffuse interstitial pneumonia. Over the next 2 years the patient did well and was in immunologic and bone marrow complete remission. Unfortunately, 3 years after treatment, the myeloma relapsed with detectable M-protein. Three and one-half years after transplant, clinical relapse occurred with bone pain and lytic lesions necessitating additional radiation and chemotherapy. Salvage therapy has produced clinical improvement and the patient is alive almost 4 years from transplant and almost 7 years from diagnosis. Although intense chemoradiotherapy did not cure this patient, substantial control of a refractory tumor was observed. This case, together with other cases of intense therapy for myeloma which are reviewed in this paper, support the concept of high-dose therapy and should foster further investigation of high-dose therapy.

Late and localized extramedullary relapse of a light chain kappa myeloma after syngeneic bone marrow transplantation

“…[4][5][6] The largest series reported includes 11 patients and in five of them complete remission (CR) was achieved after high-dose cyclophosphamide and TBI. In four of the five patients, having IgG kappa MM, the CR was maintained for years.…”

“…A small number of MM patients treated with syngeneic BMT have been reported in the literature and in some of them prolonged remissions have been observed. [4][5][6] In this report, we describe a MM patient with a localized and extramedullary relapse after a 7-year remission following syngeneic BMT. …”

ALLOGENEIC STEM CELL TRANSPLANTATION FOR MULTIPLE MYELOMA

“…Two studies have reported the long‐term follow‐up of patients who received syngeneic bone marrow transplants for multiple myeloma. The first study in 1996 reported the Seattle experience in 11 patients with advanced myeloma (29–31). All patients received myeloablative therapy; (5 patients 45%) achieved CR and (3 patients 27%) had a PR.…”