Sequential, cycling maintenance therapy for post transplant multiple myeloma

Christine I. Chen, S. Nanji, A. Prabhu, R. Beheshti, Q. L. Yi, D. Sutton, Alexander Keith Stewart

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

High-dose chemotherapy with autologous stem cell transplantation in patients with newly diagnosed multiple myeloma can prolong survival but is not curative. Maintenance therapy post transplant may prolong the disease-free interval and impact overall survival. We have conducted a phase II pilot study of 28 post transplant myeloma patients treated with a sequential, cycling maintenance regimen. The regimen was designed to include a variety of active myeloma agents chosen for ease of administration to enhance patient compliance and scheduled sequentially to minimize toxicity. The 12-month cycling schedule included dexamethasone (months 1-3); melphalan and prednisone (months 4, 5); cyclophosphamide and prednisone (months 6, 7); α-interferon (months 8-10); followed by a drug holiday (months 11, 12). The regimen was generally well tolerated with five patients developing reversible grade III -IV toxicity (diabetes-induced hyperglycemia in four, neutropenia in one). There was one toxic death on study due to non-neutropenic pneumonia and sepsis. Median event-free survival from transplant was 36.9 months (95% CI 23.6 - upper limit not yet reached) with median overall survival not yet reached at a median follow-up of 44 months. This concept of cycling, sequential maintenance with various agents, perhaps including newer biological, targeted agents, warrants further investigation in multiple myeloma.

Original languageEnglish (US)
Pages (from-to)89-94
Number of pages6
JournalBone Marrow Transplantation
Volume37
Issue number1
DOIs
StatePublished - Jan 2006
Externally publishedYes

Fingerprint

Multiple Myeloma
Prednisone
Transplants
Survival
Maintenance
Holidays
Melphalan
Poisons
Biological Factors
Stem Cell Transplantation
Patient Compliance
Neutropenia
Hyperglycemia
Cyclophosphamide
Interferons
Dexamethasone
Disease-Free Survival
Sepsis
Pneumonia
Appointments and Schedules

Keywords

  • Alkylating agents
  • Glucocorticosteroids
  • Interferon
  • Maintenance theraphy
  • Multiple myeloma
  • Stem cell transplant

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Sequential, cycling maintenance therapy for post transplant multiple myeloma. / Chen, Christine I.; Nanji, S.; Prabhu, A.; Beheshti, R.; Yi, Q. L.; Sutton, D.; Stewart, Alexander Keith.

In: Bone Marrow Transplantation, Vol. 37, No. 1, 01.2006, p. 89-94.

Research output: Contribution to journalArticle

Chen, Christine I. ; Nanji, S. ; Prabhu, A. ; Beheshti, R. ; Yi, Q. L. ; Sutton, D. ; Stewart, Alexander Keith. / Sequential, cycling maintenance therapy for post transplant multiple myeloma. In: Bone Marrow Transplantation. 2006 ; Vol. 37, No. 1. pp. 89-94.
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