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Monoclonal antibody-purged autologous bone marrow transplantation therapy
for multiple myeloma
KC Anderson, BA Barut, J Ritz, AS Freedman, T Takvorian, SN Rabinowe, R Soiffer, L Heflin, F Coral and K Dear
Division of Tumor Immunology, Dana-Farber Cancer Institute, Boston, MA
02115.
Eleven patients with plasma cell dyscrasias underwent high-dose
chemoradiotherapy and anti-B-cell monoclonal antibody (MoAb)-treated
autologous bone marrow transplantation (ABMT). The majority of patients had
advanced Durie-Salmon stage myeloma at diagnosis, all were pretreated with
chemotherapy, and six had received prior radiotherapy. At the time of ABMT,
all patients demonstrated good performance status with Karnofsky score of
80% or greater and had less than 10% marrow tumor cells. Eight patients had
residual monoclonal marrow plasma cells and 10 patients had paraprotein.
Following high-dose melphalan and total body irradiation (TBI) there were
seven complete responses, three partial responses, and one toxic death.
Granulocytes greater than 500/mm3 were noted at a median of 21 (range 12 to
46) days posttransplant (PT) and untransfused platelets greater than
20,000/mm3 were noted at a median of 23 (12 to 53) days PT in 10 of the 11
patients. Natural killer cells and cytotoxic/suppressor T cells
predominated early PT, with return of B cells at 3 months PT and
normalization of T4:T8 ratio at 1 year PT. Less than 5% polyclonal marrow
plasma cells were noted in all patients after transplant. Three of the
seven complete responders have had return of paraprotein, two with myeloma,
and have subsequently responded to alpha 2 interferon therapy. Eight
patients are alive at 18.9 (8.9 to 43.1) months PT and four remain
disease-free at 12.3, 17.5, 18.9, and 29 months PT. This preliminary study
confirms that high-dose melphalan and TBI can achieve high response rates
without unexpected toxicity in patients who have sensitive disease, and
that MoAb-based purging techniques do not inhibit engraftment. Although the
follow-up is short- and long-term outcome to be determined, relapses
post-ABMT in these heavily pretreated patients suggest that ABMT or
alternative treatment strategies should be evaluated earlier in the disease
course.
Volume 77,
Issue 4,
pp. 712-720,
02/15/1991
Copyright © 1991 by The American Society of Hematology
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