Long-term follow up of sequential mobilisation and autologous transplantation with CD34-selected cells in multiple myeloma: a multimodality approach

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dc.contributor.authorHorvath, N.
dc.contributor.authorHahn, U.
dc.contributor.authorJoshua, D.
dc.contributor.authorDyson, P.
dc.contributor.authorGibson, J.
dc.contributor.authorStevens, J.
dc.contributor.authorRawling, T.
dc.contributor.authorBarrow, L.
dc.contributor.authorBrown, R.
dc.contributor.authorStevens, S.
dc.contributor.authorGower, G.
dc.contributor.authorNorman, J.
dc.contributor.authorMills, B.
dc.contributor.authorTo, L.
dc.date.issued2004
dc.description.abstract<h4>Background</h4>Even after high dose chemotherapy (HDT) and autologous haemopoietic stem cell transplantation, the majority of patients with multiple myeloma eventually relapse.<h4>Aim</h4>The aim of the present study was to study the -feasibility and outcome of delivering a regimen including in vivo and in vitro purging and double HDT in patients with multiple myeloma.<h4>Methods</h4>Thirty-four patients with advanced multiple myeloma were enrolled in a program of vincristine, doxorubicin and dexamethasone chemotherapy, high dose cyclophosphamide/granulocyte macrophage colony stimulating factor (GM-CSF) stem cell mobilisation, CD34 selection of harvested stem cells (in vitro purging), double HDT (cyclophosphamide/epirubicin in the first, busulphan/melphalan in the second) rescued by CD34(+)-selected cells, the second rescue using cells harvested following the first HDT (in vivo purging) and interferon maintenance.<h4>Results</h4>Forty-four per cent of patients completed the program. Fifty-three per cent of withdrawals were as a result of insufficient stem cells. This correlated to previous chemotherapy. Therapy-related mortality was 6%. CD34(+) selection achieved more than a 2-log reduction of CD38(++) cells; in vivo purging achieved 80%. Although similar numbers of CD34(+) cells were reinfused at both HDT, platelet recovery was slower after the second HDT. Additional complete remissions were achieved after each phase of therapy, 3% at the end of vincristine, doxorubicin and dexamethasone and 33% after completing planned HDT. Factors associated with longer overall survival included age less than 60 years (P = 0.044), serum beta-2-microglobulin below 3 micro gamma/L at entry (P = 0.042) and less than 2 months between the two HDT (P = 0.024). The only factor associated with a longer event-free survival was less than 2 months between HDT on study (P = 0.038).<h4>Conclusions</h4>(i) dose intensification with two HDT delivered within 2 months might be associated with a better patient outcome, (ii) early mobilisation should be incorporated in multiple myeloma HDT programs and (iii) higher CD34(+) doses may be required for tandem transplants.
dc.identifier.citationInternal Medicine Journal, 2004; 34(4):167-175
dc.identifier.doi10.1111/j.1444-0903.2004.00552.x
dc.identifier.issn1444-0903
dc.identifier.issn1445-5994
dc.identifier.urihttp://hdl.handle.net/2440/9905
dc.language.isoen
dc.publisherBlackwell Publishing Asia
dc.source.urihttps://doi.org/10.1111/j.1444-0903.2004.00552.x
dc.subjectmultiple myeloma
dc.subjectin vivo purge
dc.subjecttandem autotransplantation
dc.subjectCD34⁺ selection
dc.titleLong-term follow up of sequential mobilisation and autologous transplantation with CD34-selected cells in multiple myeloma: a multimodality approach
dc.typeJournal article
pubs.publication-statusPublished

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