Haematologica 2003 - Supplements

cells could be harvested following chemotherapy and growth
factor, or growth factor alone. Mobilization with filgrastrim alone
avoids the morbidity associated with chemotherapy-induced
neutropenia, and is more conducive for planning ahead for
dialysis.
Study Regimen No.
of
Pts
TX1:
Mel 200
Badros Mel 140
[3] TX2:
Mel 200
Ballester
[4]
Mel 140
Bu 16 Cy
120
Tosi [5] Bu 12
Mel 80
Mel 80
81
60
21
31
24
No. on
HD
38 6%
13 13%
ED EFS OS
48%
at 3
yrs
55% at 3
yrs
7
6 3 1 5 alive in
remission
6+ - 39+
6 1 0 2+,
15+,
16+
5 alive 2
+ 26+
High-dose therapy: Melphalan is administered over 30 minutes;
the total dose could be administered in one or two days. Thus
dialysis can be avoided during the day of melphalan
administration. The stem cell could be reinfused 24 hours after
melphalan. The dialysis could be done prior to stem cell
administration. And, for patients not dialysis, attention to the
hematocrit of the stem cell products and administering stem cells
in divided doses may avoid further worsening of renal function.
The hematopoietic recovery has been shown to be prompt, and
comparable to patients without renal impairment.
The toxicity during the neutropenic phase is generally higher, and
is dose dependent. Mucositis incidence and severity is higher
among patients receiving melphalan at 200 mg/M 2 as compared
to patients receiving a lower dose of melphalan. Pulmonary
complications, often requiring ventilatory support, are more
common with the higher dose of melphalan and in patients
requiring hemodialysis. Transplant-related mortality is is less
when the dose of melphalan is lower and tandem transplant is
avoided.
As in the case of standard therapy, once the patient achieves a
remission, the outcome of high-dose therapy is comparable
between patients with or without renal failure. Only a small
proportion of patients on dialysis at the time transplantation
become dialysis independent post transplant. With proper
planning and dose modification, it should be possible to keep
transplant-related mortality to fewer than 5%.
References:
1. Blade, J., et al., Renal failure in multiple myeloma: presenting
features and predictors of outcome in 94 patients from a single
institution. Arch Intern Med, 1998. 158(17): p. 1889-93.
2. Tricot, G., et al., Safety of autotransplants with high-dose
melphalan in renal failure: a pharmacokinetic and toxicity
study. Clin Cancer Res, 1996. 2(6): p. 947-52.
3. Badros, A., et al., Results of autologous stem cell transplant in
multiple myeloma patients with renal failure. Br J Haematol,
2001. 114(4): p. 822-9.
4. Ballester, O.F., et al., High-dose chemotherapy and autologous
peripheral blood stem cell transplantation in patients with
multiple myeloma and renal insufficiency. Bone Marrow
Transplant, 1997. 20(8): p. 653-6.
5. Tosi, P., et al., Safety of autologous hematopoietic stem cell
transplantation in patients with multiple myeloma and chronic
renal failure. Leukemia, 2000. 14(7): p. 1310-3.
P10.3.3
ASCT IN SPECIAL CONDITION: OLD PEOPLE
M. Boccadoro, G. Aitoro, A. Bertola, S. Bringhen, B. Bruno,
F. Cavallo, P. Falco, M. Rotta, M. Massaia, A. Pileri, and A.
Palumbo.
From the Divisione di Ematologia dell'Università di Torino, Azienda
Ospedaliera S. Giovanni Battista, Torino, Italy;
Age is the simplest and most important variable to assess the
treatment strategy in the majority of patients at presentation.
Thus, in the absence of other clinical complications such as renal
failure, there is no controversy about the treatment strategy to be
adopted for the patient subgroups over 70, and under 60. The
best strategy for patients between 60 and 70 has still to be
defined.
In patients over 70 conventional chemotherapy continues to play
an important role since they represent about 50% of the whole
MM patient population at presentation. High-dose chemotherapy
has been successfully applied to selected patient subgroups only.
In patients below 60, the superiority of high-dose chemotherapy
has been definitively demonstrated. In patients between 60 and 70
the available high-dose regimens are probably still too toxic, and
new and less toxic approaches should be designed. The strategy
we tested in patients with age between 60 and 70 is to administer
repeated, low Melphalan doses (100 mg/m 2 ) followed by PBPC
support. In a preliminary experience carried out in 71 patients,
Melphalan 100 mg/m 2 (MEL100) was well tolerated in elderly
myeloma patients and showed higher response rate and prolonged
event-free survival in comparison with an historical MP control.
To ensure the clinical advantage of this procedure a prospective
randomized trial comparing MEL100 versus MP has been carried
out among several Italian Hematology Departments (Italian
Multiple Myeloma Study Group), and preliminary results indicate
that the single center experience has been confirmed. Thus,
MEL100 is superior to MP, but it is still unclear the effectiveness
of MEL100 versus the conventional dose (MEL200) in this
patient population between 60 and 70. Ninety patients at
diagnosis were treated with two MEL100 courses between 1994
and 2001. The clinical outcome was compared with a control
group of 90 pair mates matched for serum Beta-2 microglobulin
levels and Durie and Salmon clinical stage, and treated at
diagnosis with MEL200 courses. MEL 100 was less toxic than
MEL200, MEL 100 was inferior to MEL 200 in term of EFS but
not in terms of OS. MEL 100 represents a suitable option for
elderly patients, especially for those with concurrent diseases.
P10.3.4
AMYLOIDOSIS/POEMS
Gertz M
Introduction:
Amyloidosis results from the extracellular deposition of insoluble
immunoglobulin light chain fragments in the heart, kidneys, liver
and nerves, which leads to progressive dysfunction of these
organs and ultimately to death. The median survival is from 12-
17 months. POEMS syndrome, also known as osteosclerotic
multiple myeloma, is a monoclonal plasma cell disorder. It
produces systemic symptoms that include polyneuropathy,
endocrinopathy, and often pulmonary hypertension. In both
disorders there is a clonal population of plasma cells, generally
less than 10%. We review the outcomes of patients with
amyloidosis and POEMS syndrome that received high dose
therapy with stem cell reconstitution in an attempt to manage the
syndrome.
Amyloidosis:
S63