Final outcomes of escalated melphalan 280 mg/m 2 with amifostine cytoprotection followed autologous hematopoietic stem cell transplantation for multiple myeloma: high CR and VGPR rates do not translate into improved survival

Parameswaran Hari, Donna E. Reece, Jasleen Randhawa, Neal Flomenberg, Dianna S. Howard, Ashrof Z. Badros, Aaron P. Rapoport, Barry R. Meisenberg, Joanne Filicko-Ohara, Gordon L. Phillips, David H. Vesole

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

The most common preparative regimen for autologous transplantation (ASCT) in myeloma (MM) consists of melphalan 200 mg/m 2 (MEL 200). Higher doses of melphalan 220–260 mg/m 2 , although relatively well tolerated, have not shown significant improvement in clinical outcomes. Several approaches have been pursued in the past to improve CR rates, including poly-chemotherapy preparative regimens, tandem ASCT, consolidation, and/or maintenance therapy. Since there is a steep dose–response effect for intravenous melphalan, we evaluated an alternative single ASCT strategy using higher-dose melphalan at 280 mg/m 2 (MEL 280) with amifostine as a cytoprotectant as the maximum tolerated dose determined in an earlier phase I dose escalation trial. We report the final long-term outcomes of MM patients who underwent conditioning with MEL 280 with amifostine cytoprotection followed by ASCT. Although the complete response rate was quite high in the era pre-dating the routine use of novel therapies (proteasome inhibitors, immunomodulatory agents) (49%), the progression-free survival was a disappointing 22 months. The implications of this dichotomy between the excellent depth of ASCT response and progression-free survival are discussed.

Original languageEnglish (US)
Pages (from-to)293-299
Number of pages7
JournalBone Marrow Transplantation
Volume54
Issue number2
DOIs
StatePublished - Feb 1 2019

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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