Acute lymphoblastic leukaemia-type intensive chemotherapy to eliminate minimal residual disease after high-dose melphalan and autologous transplantation in multiple myeloma - A phase I/II feasibility and tolerance study of 17 patients

R. L. Powles, B. Sirohi, S. Kulkarni, N. Bhagwati, R. Saso, N. Raje, C. Horton, S. Singhal, J. Mehta, J. Treleaven

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Aiming to target the minimal residual disease in patients with multiple myeloma, a phase I/II single centre study was undertaken for feasibility and tolerance of intensive acute lymphoblastic leukaemia consolidation chemotherapy (ALL-IC) as part of a strategy for post-transplant consolidation targeted at pre-B cells. Seventeen newly diagnosed patients with myeloma (median age 55 years; 30-65) were initially treated with courses of infused cyclophosphamide, vincristine, adriamycin and methylprednisolone (C-VAMP) followed by melphalan 200 mg/m2 (HDM) and peripheral blood stem cell rescue (PBSC). Forty-seven percent were in CR and the rest in PR after HDM. ALL-IC consisted of vincristine, daunorubicin, etoposide, cytarabine, 6-thioguanine and prednisolone given over 5 days. All patients became neutropenic (< 0.5 x 109/l) at a median of 10 days (4-18) and one of the 17 patients (5.8%) died 15 days post ALL-IC of sepsis. A further four have died of relapse with an overall survival (OS) of 67% at 4 years. Two of nine patients in PR at the time of ALL-IC achieved CR. Matched-pair analysis of 34 control patients shows no difference for OS and event-free survival between ALL-IC and controls. We conclude that ALL-IC given to myeloma patients after HDM/PBSC is as safe as when used in ALL and warrants further assessment in randomised trials for myeloma.

Original languageEnglish (US)
Pages (from-to)949-956
Number of pages8
JournalBone Marrow Transplantation
Volume25
Issue number9
DOIs
StatePublished - 2000

Keywords

  • Lymphoblastic leukaemia treatment
  • MRD
  • Myeloma

ASJC Scopus subject areas

  • Transplantation
  • Hematology

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