Three-step high-dose sequential chemotherapy in patients with newly diagnosed multiple myeloma

Alberto Ballestrero, Fabio Ferrando, Maurizio Miglino, Marino Clavio, Roberta Gonella, Anna Garuti, Raffaella Grasso, Riccardo Ghio, Enrico Balleari, Marco Gobbi, Franco Patrone

Research output: Contribution to journalArticle

Abstract

Background and objectives: High-dose chemotherapy (HDT) with autologous peripheral blood progenitor cell (PBPC) transplant has been increasingly used for newly diagnosed multiple myeloma (MM) in recent years. Presently available results suggest an improvement in the complete remission rate and survival as compared to conventional chemotherapy. However, there is no plateau in the survival curves, and experiments with new treatment schedules and conditioning regimens are warranted. Design and methods: In a non-randomised controlled trial, 20 patients underwent three-step HDT following conventional vineristine/doxo ulicin/dexamethasone (VAD)-based induction. In the intensification phase patients received high-dose cyclophosphamide (HD-CY), high-dose etoposide (HD-VP), and mitoxantrone (NOV) plus melphalan (L-PAM) with haemopoietic rescue. Maintenance treatment with interferon was given until relapse. Actuarial overall survival (OS) and event-free survival (EFS) curves were plotted according to the method of Kaplan and Meier. In five of the eight patients achieving complete remission (CR), the molecular disease was monitored by polymerase chain reaction technique (PCR). Results: Overall 18/20 (90%) patients responded, with a CR rate of 40%. After an average follow-up of 40 months, median EFS and OS are 25.5 and 44.6 months, respectively. Monoclonal cells were detectable in the post-treatment bone marrow and in the aphereses of the five CR patients monitored by PCR. Conclusion: The present three-step HDT regimen, including conditioning with mitoxantrone and melphalan, proved to be feasible and safe. Our results are in agreement with the hypothesis that HDT results in an increased remission rate and in prolonged survival in newly diagnosed MM, but a cure is unlikely.

Original languageEnglish
Pages (from-to)101-106
Number of pages6
JournalEuropean Journal of Haematology
Volume68
Issue number2
DOIs
Publication statusPublished - 2002

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Multiple Myeloma
Melphalan
Drug Therapy
Mitoxantrone
Survival
Disease-Free Survival
Polymerase Chain Reaction
Blood Component Removal
Etoposide
Cyclophosphamide
Interferons
Dexamethasone
Blood Cells
Appointments and Schedules
Stem Cells
Therapeutics
Survival Rate
Bone Marrow
Transplants
Recurrence

Keywords

  • Autologous transplantation
  • High-dose chemotherapy
  • Multiple myeloma
  • Peripheral blood progenitor cell

ASJC Scopus subject areas

  • Hematology

Cite this

Three-step high-dose sequential chemotherapy in patients with newly diagnosed multiple myeloma. / Ballestrero, Alberto; Ferrando, Fabio; Miglino, Maurizio; Clavio, Marino; Gonella, Roberta; Garuti, Anna; Grasso, Raffaella; Ghio, Riccardo; Balleari, Enrico; Gobbi, Marco; Patrone, Franco.

In: European Journal of Haematology, Vol. 68, No. 2, 2002, p. 101-106.

Research output: Contribution to journalArticle

Ballestrero, Alberto ; Ferrando, Fabio ; Miglino, Maurizio ; Clavio, Marino ; Gonella, Roberta ; Garuti, Anna ; Grasso, Raffaella ; Ghio, Riccardo ; Balleari, Enrico ; Gobbi, Marco ; Patrone, Franco. / Three-step high-dose sequential chemotherapy in patients with newly diagnosed multiple myeloma. In: European Journal of Haematology. 2002 ; Vol. 68, No. 2. pp. 101-106.
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abstract = "Background and objectives: High-dose chemotherapy (HDT) with autologous peripheral blood progenitor cell (PBPC) transplant has been increasingly used for newly diagnosed multiple myeloma (MM) in recent years. Presently available results suggest an improvement in the complete remission rate and survival as compared to conventional chemotherapy. However, there is no plateau in the survival curves, and experiments with new treatment schedules and conditioning regimens are warranted. Design and methods: In a non-randomised controlled trial, 20 patients underwent three-step HDT following conventional vineristine/doxo ulicin/dexamethasone (VAD)-based induction. In the intensification phase patients received high-dose cyclophosphamide (HD-CY), high-dose etoposide (HD-VP), and mitoxantrone (NOV) plus melphalan (L-PAM) with haemopoietic rescue. Maintenance treatment with interferon was given until relapse. Actuarial overall survival (OS) and event-free survival (EFS) curves were plotted according to the method of Kaplan and Meier. In five of the eight patients achieving complete remission (CR), the molecular disease was monitored by polymerase chain reaction technique (PCR). Results: Overall 18/20 (90{\%}) patients responded, with a CR rate of 40{\%}. After an average follow-up of 40 months, median EFS and OS are 25.5 and 44.6 months, respectively. Monoclonal cells were detectable in the post-treatment bone marrow and in the aphereses of the five CR patients monitored by PCR. Conclusion: The present three-step HDT regimen, including conditioning with mitoxantrone and melphalan, proved to be feasible and safe. Our results are in agreement with the hypothesis that HDT results in an increased remission rate and in prolonged survival in newly diagnosed MM, but a cure is unlikely.",
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T1 - Three-step high-dose sequential chemotherapy in patients with newly diagnosed multiple myeloma

AU - Ballestrero, Alberto

AU - Ferrando, Fabio

AU - Miglino, Maurizio

AU - Clavio, Marino

AU - Gonella, Roberta

AU - Garuti, Anna

AU - Grasso, Raffaella

AU - Ghio, Riccardo

AU - Balleari, Enrico

AU - Gobbi, Marco

AU - Patrone, Franco

PY - 2002

Y1 - 2002

N2 - Background and objectives: High-dose chemotherapy (HDT) with autologous peripheral blood progenitor cell (PBPC) transplant has been increasingly used for newly diagnosed multiple myeloma (MM) in recent years. Presently available results suggest an improvement in the complete remission rate and survival as compared to conventional chemotherapy. However, there is no plateau in the survival curves, and experiments with new treatment schedules and conditioning regimens are warranted. Design and methods: In a non-randomised controlled trial, 20 patients underwent three-step HDT following conventional vineristine/doxo ulicin/dexamethasone (VAD)-based induction. In the intensification phase patients received high-dose cyclophosphamide (HD-CY), high-dose etoposide (HD-VP), and mitoxantrone (NOV) plus melphalan (L-PAM) with haemopoietic rescue. Maintenance treatment with interferon was given until relapse. Actuarial overall survival (OS) and event-free survival (EFS) curves were plotted according to the method of Kaplan and Meier. In five of the eight patients achieving complete remission (CR), the molecular disease was monitored by polymerase chain reaction technique (PCR). Results: Overall 18/20 (90%) patients responded, with a CR rate of 40%. After an average follow-up of 40 months, median EFS and OS are 25.5 and 44.6 months, respectively. Monoclonal cells were detectable in the post-treatment bone marrow and in the aphereses of the five CR patients monitored by PCR. Conclusion: The present three-step HDT regimen, including conditioning with mitoxantrone and melphalan, proved to be feasible and safe. Our results are in agreement with the hypothesis that HDT results in an increased remission rate and in prolonged survival in newly diagnosed MM, but a cure is unlikely.

AB - Background and objectives: High-dose chemotherapy (HDT) with autologous peripheral blood progenitor cell (PBPC) transplant has been increasingly used for newly diagnosed multiple myeloma (MM) in recent years. Presently available results suggest an improvement in the complete remission rate and survival as compared to conventional chemotherapy. However, there is no plateau in the survival curves, and experiments with new treatment schedules and conditioning regimens are warranted. Design and methods: In a non-randomised controlled trial, 20 patients underwent three-step HDT following conventional vineristine/doxo ulicin/dexamethasone (VAD)-based induction. In the intensification phase patients received high-dose cyclophosphamide (HD-CY), high-dose etoposide (HD-VP), and mitoxantrone (NOV) plus melphalan (L-PAM) with haemopoietic rescue. Maintenance treatment with interferon was given until relapse. Actuarial overall survival (OS) and event-free survival (EFS) curves were plotted according to the method of Kaplan and Meier. In five of the eight patients achieving complete remission (CR), the molecular disease was monitored by polymerase chain reaction technique (PCR). Results: Overall 18/20 (90%) patients responded, with a CR rate of 40%. After an average follow-up of 40 months, median EFS and OS are 25.5 and 44.6 months, respectively. Monoclonal cells were detectable in the post-treatment bone marrow and in the aphereses of the five CR patients monitored by PCR. Conclusion: The present three-step HDT regimen, including conditioning with mitoxantrone and melphalan, proved to be feasible and safe. Our results are in agreement with the hypothesis that HDT results in an increased remission rate and in prolonged survival in newly diagnosed MM, but a cure is unlikely.

KW - Autologous transplantation

KW - High-dose chemotherapy

KW - Multiple myeloma

KW - Peripheral blood progenitor cell

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