High-Dose Intravenous Melphalan for Plasma-Cell Leukaemia and Myeloma

McElwain, T. J.; Powles, R

doi:10.1016/s0140-6736(83)90739-0

Cited by 472 publications

(229 citation statements)

References 7 publications

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“…Outagents. 3,4 As a result, numerous clinical trials have patients were more often younger, with better stem cell employed autologous stem cells, as well as colony-stimulatproducts, normal serum albumin and ␤-2-microglobuing factors, to support myeloablative therapy for MM. 5-9 A lin levels as well as chemotherapy-sensitive disease comrandomized clinical trial by French investigators has shown pared to inpatients.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and cost-effectiveness of outpatient autotransplants in multiple myeloma

Jagannath

Vesole

Zhang³

et al. 1997

Bone Marrow Transplant

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Summary:chemotherapy does not exceed 5-10%. Advanced age (median, 65 years), renal function impairment and hematoThis report summarizes 2 years experience in perpoietic stem cell compromise due to prolonged alkylating forming 336 autotransplant procedures in 251 consecuagent therapy have delayed evaluation of high-dose chemotive patients with multiple myeloma, using high-dose therapy in MM, an approach that has proven to be successmelphalan at 200 mg/m 2 in the context of a tandem ful in the management of lymphomas. 2 Pilot studies in the transplant program. A total of 91 patients received 118 early 1980s revealed that drug-resistance in advanced MM transplants as outpatients while the remaining 160 could be overcome by dose-escalation of alkylating patients received 218 transplants as inpatients. Outagents. 3,4 As a result, numerous clinical trials have patients were more often younger, with better stem cell employed autologous stem cells, as well as colony-stimulatproducts, normal serum albumin and ␤-2-microglobuing factors, to support myeloablative therapy for MM. 5-9 A lin levels as well as chemotherapy-sensitive disease comrandomized clinical trial by French investigators has shown pared to inpatients. There were no differences in hemaautotransplant to be superior to standard chemotherapy in topoietic recovery and non-hematologic toxicities the management of newly diagnosed symptomatic myeloma between outpatient and inpatient transplant recipients.patients. 10 In the interest of offering this promising treatPost-transplant febrile neutropenia and most other ment strategy to a larger MM patient population, outpatient post-transplant toxicities were managed successfully in transplants were initiated at our institution and their safety, an ambulatory setting. Although liberal criteria were efficacy, and cost-effectiveness were examined. developed for hospitalization of outpatients, including High-dose melphalan was chosen as cytoreductive regiclinical parameters as well as patient desire and men because of its relative lack of extra-medullary toxicity, physician/nurse judgment, only 21% of outpatients even at 200 mg/m 2 . 11,12 The initiation of outpatient transrequired admission after transplantation. Median hosplants required a high degree of proficiency on the part of pital stay for these outpatients was 9 days, while inpathe transplant team and an adequate outpatient nursing and tients were hospitalized for a median of 15 days (P ‫؍‬ pharmacy infrastructure to ensure continuity of care, even 0.0001). After adjusting for differences in disease and at weekends. Because only two outpatient autotransplant host features, our study showed outpatient management procedures could be accommodated per week, patient perresulted in significant financial savings due to lower formance status and preference, as well as third-party pharmacy (42%), hospitalization (50%) and insurance payments influenced whether or not a patient was pathology/laboratory charges (36%). We conclude that accepted for outpatient transplantation....

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Section: Discussionmentioning

confidence: 99%

Feasibility and cost-effectiveness of outpatient autotransplants in multiple myeloma

Jagannath

Vesole

Zhang³

et al. 1997

Bone Marrow Transplant

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“…Thus, high-dose therapy was introduced in the treatment of MM and was shown to improve response rates (McElwain & Powles, 1983;Barlogie et al, 1986), disease-free and overall survival in comparative studies with standard chemotherapy (Attal et al, 1996;Barlogie et al, 1997). However, the chance of definitive cure with this treatment modality is low, especially in patients with high-risk parameters (Desikan et al, 2000).…”

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confidence: 99%

Follow‐up of patients with progressive multiple myeloma undergoing allografts after reduced‐intensity conditioning

Einsele¹,

Schäfer²,

Hebart³

et al. 2003

Br J Haematol

107

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Summary. Allogeneic stem cell transplantation (allo‐SCT) after reduced‐intensity conditioning was evaluated in 22 patients (median age 53, range 36–66 years) with multiple myeloma with progression after an autologous SCT. Seven patients received a transplant from a human leucocyte antigen (HLA)‐identical sibling and 15 patients (68%) from an unrelated donor [including 3/22 (14%) from a HLA‐mismatched unrelated donor]. Graft‐versus‐host disease (GVHD) prophylaxis consisted of serotherapy with antithymocyte globulin (ATG) and cyclosporine (CSA) (n = 12) or CSA plus mycophenolate mofetil (n = 10). Despite of heavy pretreatment, the transplant‐related mortality (TRM) for all grafted patients was acceptable at 5/22 patients (23%). Seven of 21 patients (33%) that were evaluated developed grade II GVHD and one (5%) patient developed grade III/IV acute GVHD. Seven patients developed chronic GVHD (cGVHD), but only one was extensive. Eleven patients died of progressive disease within a median of 7 months (2–19 months) post transplant. Thirteen of all 22 patients (59%) achieved a partial or complete remission with six of these 13 patients (46%) remaining event free at a median of 24 months (range 8–36 months) post allografting. Estimated 2 year overall and event‐free survival was, respectively, 25·5% and 22·0% for the whole patient group, and 62·5% and 57·1% for patients with chemosensitive disease. Chemorefractory disease prior to allogeneic stem cell transplantation (P = 0·0182) and absence of cGVHD (P = 0·069) were associated with shorter event‐free survival. Thus long‐term disease control can be achieved, but is restricted to patients responding to prior salvage chemotherapy.

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“…Box 100277, Gainesville, FL 32610-0277. E-mail: morebjs@medicine.ufl.edu alkylating agents result in better tumor mass reduction and higher remission rates [14,15]. Since then, single or multiple high-dose alkylating agents in combination with either TBI or other chemotherapeutic agents have been used.…”

Section: Introductionmentioning

confidence: 99%

Busulfan, cyclophosphamide, and etoposide as conditioning for autologous stem cell transplantation in multiple myeloma

et al. 2003

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Autologous stem cell transplantation (ASCT) has enabled the use of high-dose alkylating agents either as a single agent or in combination with other cytotoxic agents and/or total body irradiation (TBI) for the treatment of multiple myeloma. Despite improved complete remission rates, relapse and regimen-related toxicities remain challenging. In an effort to increase event-free survival and decrease the high incidence of regimen-related toxicity, we have studied the use of etoposide in combination with reduced-dose busulfan and cyclophosphamide as a conditioning regimen for ASCT in a group of 26 patients with advanced multiple myeloma. Median follow-up for the group was 30 months. There was no early treatment-related mortality. The main toxicity was mucositis. Otherwise, there was 1 case of reversible, clinically diagnosed hepatic veno-occlusive disease. Postengraftment, 10 patients (38%) achieved CR, 15 (58%) patients achieved PR or SD, and 1 patient developed progressive disease (4%). Five patients in PR and 1 with progressive disease before transplant attained a CR post-transplant. The median times for event-free survival and overall survival after transplantation were 24 and 43 months, respectively. In conclusion, conditioning with busulfan, cyclophosphamide, and etoposide followed by ASCT is a safe regimen with comparable effectiveness to other previously used preparative regimens, thus providing another approach of non-TBI containing high-dose chemotherapy for patients with multiple myeloma. Am. J. Hematol. 73:169-175, 2003.

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High-Dose Intravenous Melphalan for Plasma-Cell Leukaemia and Myeloma

Cited by 472 publications

References 7 publications

Feasibility and cost-effectiveness of outpatient autotransplants in multiple myeloma

Feasibility and cost-effectiveness of outpatient autotransplants in multiple myeloma

Follow‐up of patients with progressive multiple myeloma undergoing allografts after reduced‐intensity conditioning

Busulfan, cyclophosphamide, and etoposide as conditioning for autologous stem cell transplantation in multiple myeloma

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