melphalan and Pharyngitis

Topics: Antibodies, Monoclonal, Murine-Derived; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Transplantation; Carboplatin; Cisplatin; Cyclophosphamide; Cytarabine; Dexamethasone; Doxorubicin; Epstein-Barr Virus Infections; Etoposide; Female; Humans; Immunosuppressive Agents; Lymphoma, T-Cell, Peripheral; Melphalan; Methotrexate; Middle Aged; Nitrosourea Compounds; Pharyngitis; Prednisolone; Recurrence; Rituximab; Salvage Therapy; Tacrolimus; Transplantation Conditioning; Transplantation, Homologous; Vincristine; Whole-Body Irradiation

Between June 1989 and June 1992, 12 patients with advanced multiple myeloma underwent peripheral blood stem cell autotransplantation after high-dose chemotherapy and radiotherapy. The conditioning regimen included melphalan (140 mg/m2), high-dose cyclophosphamide (120 mg/kg), methylprednisolone (2 g daily x 7), and total body irradiation (9-12 Gy). Transplant morbidity included severe mucositis (n = 7) and acute renal failure (n = 2) related to infusion of the stem cells. Engraftment was delayed (n = 4) in this heavily pretreated population, and two patients had complete graft failure. Despite the advanced nature and chemotherapy-refractory state of their disease, 11 of 11 evaluable patients achieved an objective response. Six patients survived to leave the hospital, and four remain alive--one died of acute leukemia induced by prior melphalan exposure. Three of the four are relapse-free at a median of 24.9 months (range, 18-28 months). Some patients with advanced refractory multiple myeloma can achieve objective responses from highdose chemoradiotherapy with peripheral blood stem cell rescue. Harvesting peripheral blood stem cells from high-risk patients early in their disease for later use may decrease the risk of graft failure. Peripheral blood stem cell transplantation after high-dose chemotherapy and total body irradiation can produce durable responses in patients with advanced refractory myeloma.

Topics: Acute Kidney Injury; Adult; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Cyclophosphamide; Female; Hematopoietic Stem Cell Transplantation; Humans; Leukapheresis; Male; Melphalan; Methylprednisolone; Middle Aged; Mucous Membrane; Multiple Myeloma; Pharyngitis; Recurrence; Whole-Body Irradiation