|
|
 Previous Article | Table of Contents | Next Article 
Double-intensive therapy in high-risk multiple myeloma
JL Harousseau, N Milpied, JP Laporte, P Collombat, T Facon, JD Tigaud, P Casassus, F Guilhot, N Ifrah and C Gandhour
Department of Hematology, Nantes, France.
A high remission rate is achieved with high-dose melphalan (HDM) in
multiple myeloma (MM), and autologous transplantation of hematopoietic stem
cells allows a prompt hematologic recovery after high-dose therapy. We
treated 97 patients with high-risk MM (group 1:44 advanced MM including 14
primary resistances and 30 relapses; group 2: 53 newly diagnosed MM) with a
first course of HDM. For responding patients a second course of high-dose
therapy with hematopoietic stem cell support was proposed. After the first
HDM, the overall response and complete remission rates were 71% and 25%
with no significant difference between the two groups. The median durations
of neutropenia and thrombocytopenia were significantly longer in group 1
(29.5 days and 32 days, respectively) than in group 2 (23 days and 17 days,
respectively). This severe myelosuppression led to eight toxic deaths and
the fact that only 38 of the 69 responders could proceed to the second
course (three allogenic and 35 autologous transplantations). Among the 35
patients undergoing autologous transplantation (10 in group 1, 25 in group
2), 31 received their marrow unpurged collected after the first HDM, and
four received peripheral blood stem cells. The median durations of
neutropenia and thrombocytopenia after autologous transplantation were 24
days and 49 days, respectively. Two toxic deaths and nine prolonged
thrombocytopenias were observed. The median survival for the 97 patients
was 24 months (17 months in group 1, 37 months in group 2) and the median
duration of response was 20 months. The only parameters that have a
significant impact on the survival are the age (+/- 50 years) and the
response to HDM. The median survival of the 35 patients undergoing
autologous transplantation is 41 months, but the median duration of
remission is 28 months with no plateau of the remission duration curve.
Patients responding to HDM may have prolonged survival, but even a second
course of high-dose therapy probably cannot eradicate the malignant clone.
Volume 79,
Issue 11,
pp. 2827-2833,
06/01/1992
Copyright © 1992 by The American Society of Hematology
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
K.-S. Eom, C.-K. Min, S. Lee, Y.-J. Kim, S.-Y. Kim, H.-J. Kim, J.-W. Lee, W.-S. Min, and C.-C. Kim
Efficacy of Up-Front Treatment with a Double Stem Cell Transplantation in Multiple Myeloma
Jpn. J. Clin. Oncol.,
July 1, 2006;
36(7):
432 - 438.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Attal, J.-L. Harousseau, T. Facon, F. Guilhot, C. Doyen, J.-G. Fuzibet, M. Monconduit, C. Hulin, D. Caillot, R. Bouabdallah, et al.
Single versus Double Autologous Stem-Cell Transplantation for Multiple Myeloma
N. Engl. J. Med.,
December 25, 2003;
349(26):
2495 - 2502.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. M. Segeren, P. Sonneveld, B. van der Holt, E. Vellenga, A. J. Croockewit, G. E. G. Verhoef, J. J. Cornelissen, M. R. Schaafsma, M. H. J. van Oers, P. W. Wijermans, et al.
Overall and event-free survival are not improved by the use of myeloablative therapy following intensified chemotherapy in previously untreated patients with multiple myeloma: a prospective randomized phase 3 study
Blood,
March 15, 2003;
101(6):
2144 - 2151.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. S. Dalton, P. L. Bergsagel, W. M. Kuehl, K. C. Anderson, and J. L. Harousseau
Multiple Myeloma
Hematology,
January 1, 2001;
2001(1):
157 - 177.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Vescio, G. Schiller, A. K. Stewart, O. Ballester, S. Noga, H. Rugo, C. Freytes, E. Stadtmauer, S. Tarantolo, F. Sahebi, et al.
Multicenter Phase III Trial to Evaluate CD34+ Selected Versus Unselected Autologous Peripheral Blood Progenitor Cell Transplantation in Multiple Myeloma
Blood,
March 15, 1999;
93(6):
1858 - 1868.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Corradini, C. Voena, C. Tarella, M. Astolfi, M. Ladetto, A. Palumbo, M. T. Van Lint, A. Bacigalupo, A. Santoro, M. Musso, et al.
Molecular and Clinical Remissions in Multiple Myeloma: Role of Autologous and Allogeneic Transplantation of Hematopoietic Cells
J. Clin. Oncol.,
January 1, 1999;
17(1):
208 - 208.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Bataille and J.-L. Harousseau
Multiple Myeloma
N. Engl. J. Med.,
June 5, 1997;
336(23):
1657 - 1664.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Attal, J.-L. Harousseau, A.-M. Stoppa, J.-J. Sotto, J.-G. Fuzibet, J.-F. Rossi, P. Casassus, H. Maisonneuve, T. Facon, N. Ifrah, et al.
A Prospective, Randomized Trial of Autologous Bone Marrow Transplantation and Chemotherapy in Multiple Myeloma
N. Engl. J. Med.,
July 11, 1996;
335(2):
91 - 97.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Alexanian and M. Dimopoulos
The Treatment of Multiple Myeloma
N. Engl. J. Med.,
February 17, 1994;
330(7):
484 - 489.
[Full Text]
|
|
|
|
|
