Sequential, cycling maintenance therapy for post transplant multiple myeloma

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

Research output: Contribution to journalArticle

7 Scopus citations

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 1 2006

Keywords

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

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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