Autologous Bone Marrow Transplantation - Blog Science Connections

Myeloma Biology and Therapy 267
responded dramatically: their median tumor-halving time was only 0.3
months, and the maximum tumor cytoreduction was greater than 90%. Of
particular interest was the response in a patient with refractory primary
myeloma whose marrow autograft contained 30% tumor cells that did not
compromise the net tumor cytoreduction or duration of disease control. In
fact, all four patients continue in remission after 3-15 months (median, >8
months), which is superior to the median of 4 months for the 14 responders to
melphalan alone.
Our preliminary data, then, indicate that high-dose melphalan can be
combined effectively and relatively safely with TBI when the patient is
supported by ABMT, even in the presence of considerable marrow plasmacytosis.
The absence of major nonmyelosuppressive side effects makes this
treatment attractive for managing a disease that typically affects a more
elderly patient population. The low proliferative propensity of myeloma
plasma cells and perhaps a small tumor stem cell compartment may permit
durable remissions, even when all tumor cells have not been removed from
marrow autografts by immunologic or cytotoxic means.
SUMMARY
Major advances in the understanding of myeloma biology and therapy
have been accomplished over the past 5 years. In an effort to alter
fundamentally the natural history of myeloma in high-risk patients, those
presenting with intermediate and large tumor mass are now offered highdose
melphalan and TBI supported by autologous bone marrow transplantation
to consolidate VAD-induced remissions. For patients with a small tumor
burden, we are currently evaluating a combination of interferon and
dexamethasone, investigating whether this combination might be synergistic.
We hope that dexamethasone may ameliorate interferon-related side effects
and permit administration of higher and perhaps more effective doses of this
biologic response-modifying agent.
ACKNOWLEDGMENT
This study was supported in part by grants CA37161 and CA 28771 from
the National Institutes of Health, Bethesda, MD.
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