melphalan and Polyneuropathies

A single high-dose cycle of chemotherapy can produce response rates in excess of 50%. However, disease-free survival (DFS) is 15-20% at 5 years. The single most important predictor of prolonged DFS is achieving a complete response (CR). Increasing the proportion of patients who achieve a complete response may improve disease-free survival. Women with metastatic breast cancer and at least a partial response (PR) to induction chemotherapy received three separate high-dose cycles of chemotherapy with peripheral blood progenitor support and G-CSF. The first intensification was paclitaxel (825 mg/m(2)), the second melphalan (180 mg/m(2)) and the third consisted of cyclophosphamide 6000 mg/m(2) (1500 mg/m(2)/day x 4), thiotepa 500 mg/m(2) (125 mg/m(2)/day x 4) and carboplatin 800 mg/m(2) (200 mg/m(2)/day x 4) (CTCb). Sixty-one women were enrolled and 60 completed all three cycles. Following the paclitaxel infusion most patients developed a reversible, predominantly sensory polyneuropathy. Of the 30 patients with measurable disease, 12 converted to CR, nine converted to a PR*, and five had a further PR, giving an overall response rate of 87%. The toxic death rate was 5%. No patient progressed on study. Thirty percent are progression-free with a median follow-up of 31 months (range 1-43 months) and overall survival is 61%. Three sequential high-dose cycles of chemotherapy are feasible and resulted in a high response rate. The challenge continues to be maintenance of response and provides the opportunity to evaluate strategies for eliminating minimal residual disease.

Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Carboplatin; Cyclophosphamide; Female; Granulocyte Colony-Stimulating Factor; Humans; Melphalan; Middle Aged; Paclitaxel; Peripheral Blood Stem Cell Transplantation; Polyneuropathies; Remission Induction; Survival Analysis; Survival Rate; Thiotepa

POEMS (acronym for polyneuropathy, organomegaly, endocrinopathy, M protein myeloma and skin changes), is a rare disease which occurs in the setting of plasma cell dyscrasias. We describe a case of an adult lady who presented with gradual onset weakness of all four limbs and multisystem involvement characterized by pedal edema, ascites, hyperpigmentation and hypogonadism. Nerve conduction study showed severe sensorimotor polyneuropathy. Serum immunofixation showed lambda light chain restricted monoclonal gammopathy. Bone marrow biopsy consistent with plasma cell dyscrasia. Hormonal assay showed decreased FSH, LH and estradiol levels which led us to diagnosis of hypogonadotrophic hypogonadism. The patient responded well to combination therapy of thalidomide, melphalan and dexamethasone. Eight months after the therapy, she noted decreased paresthesias and increased strength. She had reduced edema and ascites.

Topics: Adult; Dexamethasone; Female; Humans; Hypogonadism; Melphalan; Paraproteinemias; POEMS Syndrome; Polyneuropathies; Thalidomide; Treatment Outcome

Topics: Amines; Antineoplastic Combined Chemotherapy Protocols; Biomarkers; Boronic Acids; Bortezomib; Combined Modality Therapy; Creatine Kinase, MM Form; Cyclohexanecarboxylic Acids; Dexamethasone; Drug Synergism; Female; Gabapentin; gamma-Aminobutyric Acid; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypercholesterolemia; Immunologic Factors; Kidney Diseases; Lenalidomide; Melphalan; Middle Aged; Multiple Myeloma; Peripheral Blood Stem Cell Transplantation; Polyneuropathies; Pravastatin; Pyrazines; Rhabdomyolysis; Thalidomide

No case of leukoencephalopathy has been reported associated with multiple myeloma.. We report on two patients with a very rare association of leukoencephalopathy and multiple myeloma revealed by cognitive impairment.. Chemotherapy has improved neurological and biological signs. Radiological abnormalities have been stabilized.. The authors suggest that leukoencephalopathy is probably a direct cerebral expression of malignant gammopathy.

Topics: Aged; Anti-Inflammatory Agents; Antineoplastic Agents, Alkylating; Female; Humans; Leukoencephalopathy, Progressive Multifocal; Magnetic Resonance Imaging; Male; Melphalan; Multiple Myeloma; Polyneuropathies; Prednisone

A 58-year-old woman presented with a history of premature onset of menopause, longstanding hepatosplenomegaly, monoclonal gammopathy, lower limb polyneuropathy of recent onset, diabetes mellitus, excessive perspiration and leg edema. Polyneuropathy and excessive perspiration improved following a course of prednisone and melphalan. The clinical and pathophysiological features fit the rare entity known as POEMS syndrome.

Topics: Drug Therapy, Combination; Female; Hepatomegaly; Humans; Hypergammaglobulinemia; Immunoglobulin G; Melphalan; Middle Aged; Monoclonal Gammopathy of Undetermined Significance; Polyneuropathies; Prednisone; Syndrome

Topics: Bone Neoplasms; Combined Modality Therapy; Diabetic Neuropathies; Diagnosis, Differential; Humans; Ischium; Male; Melphalan; Middle Aged; Osteolysis; Plasmacytoma; Polyneuropathies; Tomography, X-Ray Computed

Topics: Aged; Amyloidosis; Cardiomyopathies; Ecchymosis; Electrocardiography; Female; Humans; Immunoglobulin G; Melphalan; Multiple Myeloma; Muscles; Myofibrils; Polyneuropathies