Idarubicin containing regimen in multiple myeloma: preliminary results of a pilot study using a modified "TANDEM" transplant program |
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Authors: | Martinelli G Agazzi A Laszlo D Santoro P Mancuso P Pruneri G C Greco P Bertolini F |
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Institution: |
a Department of Hematology-Oncology, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
b Department of Pathology, European Institute of Oncology, IRCCS, Milan, Italy.
c Pharmacia CO, Milan, Italy. |
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Abstract: | Tandem autologous transplant actually represents a challenge in multiple myeloma treatment, but the best conditioning regimen is still under investigation. With the aim of evaluating the feasibility of a modified tandem transplant strategy, we treated 10 multiple myeloma patients after conventional first line chemotherapy with a two step conditioning regimen consisting of high-dose melphalan (200 mg/m 2 ) followed by high-dose melphalan (180 mg/m 2 ) together with indarubicin (15 mg/sqm 2 c.i. ×3 days) both with peripheral stem cell support. At first transplant, the median age was 62 years, performance status was good and disease status was CR in 2 patients and PR in the rest. At the end of the first transplant, 70% of patients achieved CR and only mild toxicity was observed. After the second transplant further improvement of the response rate was obtained with 90% CR. However, we observed three toxic early infection-related deaths from CMV and legionella pneumonia at day +17, +26, +54 after transplantation. Although this schedule seems to be effective in terms of response rate, the 30% TRM imposes an anthracycline dose-reduction with careful patient selection. This approach could reduce the toxic effects and maintain the efficacy of therapy at the same time. |
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Keywords: | Multiple Myeloma Tandem Autologous Transplant Idarubicin Melphalan |
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