Document Detail

High dose melphalan or intermediate dose melphalan can be well tolerated and result in good response rates in selected elderly patients with myeloma.
MedLine Citation:
PMID:  17324463     Owner:  NLM     Status:  MEDLINE    
We have used two strategies for treating myeloma patients aged 65-75 years. Those fit enough underwent Cyclophosphamide mobilisation and PBSCT using melphalan 200mg/m(2) (HDM) (n=15, median 67 years). Those less fit were mobilised with G-CSF and received melphalan 70mg/m(2) (IDM) (n=15, median 69 years). Where possible sufficient PBSC were collected so that patients not in CR after their first IDM, underwent a second IDM procedure (n=6). The treatment was well tolerated with zero day+100 TRM. Median cell dose was 4.85x10(6)CD34+cells/kg and 2.7x10(6) in the HDM and IDM groups, respectively. Neutrophil engraftment was faster in the HDM group but despite this there was a trend to earlier discharge in the IDM group (13 days versus 15 days) and lower antibiotic and anti-fungal usage, suggesting better tolerability. Response rates were similar with CRs achieved in 7/15 patients receiving HDM and 9/15 receiving IDM (6 after the first and 3 after the second procedure). Three patients did not undergo a second IDM due to insufficient cells. In the IDM group 11/15 remain alive at a median follow up of 14 months with 5 in CR, whilst in the HDM group 12/15 are alive with 5 in CR at a median follow up of 15.5m. We conclude both approaches have comparable efficacy but that IDM may be better tolerated in an older age group.
M Bishton; M Gilyead; E Das Gupta; C Williams; N H Russell; J L Byrne
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Publication Detail:
Type:  Journal Article     Date:  2007-02-26
Journal Detail:
Title:  Leukemia research     Volume:  31     ISSN:  0145-2126     ISO Abbreviation:  Leuk. Res.     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-06-11     Completed Date:  2007-08-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7706787     Medline TA:  Leuk Res     Country:  England    
Other Details:
Languages:  eng     Pagination:  1063-8     Citation Subset:  IM    
Department of Haematology, Nottingham City Hospital, Nottingham, UK.
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MeSH Terms
Antineoplastic Agents, Alkylating / administration & dosage*
Combined Modality Therapy
Cyclophosphamide / pharmacology
Granulocyte Colony-Stimulating Factor / pharmacology
Hematopoietic Stem Cell Mobilization
Melphalan / administration & dosage*
Multiple Myeloma / physiopathology,  therapy*
Peripheral Blood Stem Cell Transplantation*
Survival Rate
Transplantation, Autologous
Reg. No./Substance:
0/Antineoplastic Agents, Alkylating; 143011-72-7/Granulocyte Colony-Stimulating Factor; 148-82-3/Melphalan; 50-18-0/Cyclophosphamide

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