scholarly journals High Dose Therapy Followed by Autologous Peripheral Blood Stem Cell Transplantation as a First Line Treatment for Multiple Myeloma: a Korean Multicenter Study

2003 ◽  
Vol 18 (5) ◽  
pp. 673 ◽  
Author(s):  
Soo Mee Bang ◽  
Eun Kyung Cho ◽  
Cheolwon Suh ◽  
Sung Soo Yoon ◽  
Chu Myung Seong ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Peripheral Blood Stem Cell ◽  
High Dose ◽  
Line Treatment ◽  
First Line ◽  
High Dose Therapy ◽  
Blood Stem Cell Transplantation ◽  
First Line Treatment

scholarly journals Rituximab, Age and High Dose Therapy Followed By Autologus Stem Cell Transplantation Are Independent Prognostic Factors for Survival in the First Line Treatment of Primary CNS-Lymphoma

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1727-1727
Author(s):  
Michael Madle ◽  
Isabelle Herth ◽  
Nicola Lehners ◽  
Mark-Alexander Schwarzbich ◽  
Patrick Wuchter ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
High Dose ◽  
Line Treatment ◽  
First Line ◽  
High Dose Therapy ◽  
The Impact ◽  
First Line Treatment

Abstract Introduction: For patients with diffuse large B-cell lymphoma without the involvement of the CNS, the addition of rituximab to standard chemotherapy has significantly improved survival. Thus far, there have been no prospective randomized trials evaluating the impact of rituximab as part of the primary treatment of PCNSL. Methods: In this single-center, retrospective analysis, a total of 79 PCNSL-patients treated in our institution between 2000 and 2011 were included. Beside firstline chemotherapy with or without rituximab, we evaluated the impact of age (≤/> 60 years), autologous stem cell transplantation (ASCT +/-) and other factors upon overall survival (OS) and progression-free survival (PFS). Results: In patients treated with rituximab (n=27), 3-year OS was 77.8% (95%-CI:62-93%). In contrast, in patients treated without rituximab (n=52), 3-year OS was only 39.9% (CI:27-53%, Figure). The difference in OS was significant in the univariate (p=0.002) as well as the multivariate analysis (p=0.049, Hazard ratio (HR)=0.248). In the rituximab group, 80.8% were free of progression at the date of analysis (median not reached), whereas median PFS in the group without rituximab was only 17 months (CI:8-26), (p=0.001). Patients ≤ 60 years of age (n=28) had a 3-year OS of 78.2% (CI:63-94%) and a median PFS of 75 months, in patients > 60 years (n=51) 3-year OS was 38.7% (CI:25-52%) and median PFS was 39 months (CI:6-72). Patients who received high dose therapy and autologous stem cell transplantation (ASCT) had a 3-year OS of 85.2% (CI:72-99%) and 65.1% were alive up to the time of analysis (range 9-131 months). Without ASCT median OS was only 16 months (CI:11-21) and 3-year OS was 35.2% (CI:22-48%). Age and ASCT were significantly associated with better OS in univariate (p=0.002 and p=0.001) as well in multivariate analysis (p=0.004, HR=0.023 and p=0.001, HR=0.014). Conclusion: Rituximab treatment, ASCT and age are independent prognostic factors for overall survival in the first line treatment of PCNSL. Figure 1 Figure 1. Disclosures Wuchter: Sanofi: Honoraria; ETICHO: Consultancy, Honoraria.

Efficacy of Diverse High-Dose Regimens Followed by Autologous Peripheral Blood Stem Cell Transplantation in Consecutive Multiple Myeloma Patients: A Single Center Analysis over a 12 Year Period.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5478-5478
Author(s):  
Peter Haas ◽  
Kris Bauchmüller ◽  
Alexander Kühnemund ◽  
Gabriele Ihorst ◽  
Monika Engelhardt
Keyword(s):  
Multiple Myeloma ◽  
Renal Failure ◽  
Stem Cell ◽  
Side Effects ◽  
Pulmonary Fibrosis ◽  
Stem Cell Transplantation ◽  
Peripheral Blood Stem Cell ◽  
High Dose ◽  
Conditioning Regimens ◽  
Blood Stem Cell Transplantation

Abstract Over the last years, high-dose (HD) chemotherapy followed by autologous peripheral blood stem cell transplantation (auto-PBSCT) has emerged as one very effective approach to improve the outcome in multiple myeloma (MM) patients (pts). HD- regimens in MM have been Busulfan and Cyclophosphamide (Bu/Cy) and HD-Melphalan (MEL), with or without total body irradiation (TBI). In this analysis, we analyzed the efficacy of different HD-regimens in consecutive MM (pts) receiving an auto-PBSCT at our institution between 8/1992 and 1/2005. Within these 12.5 years, 120 MM pts (68 male, 52 female) received an auto-PBSCT. Their median age was 56 (27–74) years. According to Durie &Salmon (DS), stage I, II and III disease prior to PBSCT were observed in 5 (4%), 30 (25%) and 85 pts (71%), respectively. Bu/Cy was used until 1997, TBI/MEL between 1997 and 1999, and MEL alone thereafter. The respective HD-regimens consisted of Bu/Cy (Bu 16mg/kg; Cy 120mg/kg) in 15 pts (12.3%), TBI/MEL (10 Gy; MEL 140 mg/m2) in 16 pts (13.1%) and MEL (200mg/m2) in 89 pts (73.0%). The median OS of all MM pts after auto-PBSCT in our analysis was 59.5 months. The therapy related mortality (d0 – d+100 after PBSCT) was 0% (0/15) for Bu/Cy, 3.4% (3/89) for MEL alone and 6.3% (1/16) for TBI/MEL. Main Bu/Cy side effects were infections (n=4), pulmonary fibrosis (n=2), renal failure (n=1) and VOD (n=1). Infections, mostly fever of unknown origin, were observed in the MEL and TBI/MEL group in 68/89 and 15/16 pts, respectively, however in none, pulmonary fibrosis, renal failure or VOD occurred. Comparing Bu/Cy- vs. MEL-conditioning in terms of OS, Bu/Cy prolonged OS in some pts (77.2 vs. 55.6 months, p=0.12), however, this difference failed to be of statistical significance. Our analysis on the influence of TBI on MEL-conditioning revealed no advantage for the combination-therapy (55.6 (+TBI) vs. 59.5 months (−TBI)), which confirms previous studies, also show no benefit for the addition of TBI. In conclusion, our data verify that comparable remission and OS rates can be obtained with less toxic conditioning regimens in MM, such as MEL200 alone, thereby significantly reducing therapy-related side effects. Since auto-PBSCT is an effective treatment option also for elderly and frail MM pts, choosing the best conditioning regimen is important and should improve the treatment outcome in MM further. Current studies are assessing the use of tandem-transplantations and novel anti-MM-agents, such as Bortezomib, Revlimid, Thalidomide and others, before, with and after high-dose regimens. These treatment concepts make highly effective but less toxic conditioning regimens imperative for auto- and allo-transplantations.

Combination of Bortezomib and Dexamethasone (VD) or Bortezomib, Adriamycine and Dexamethasone (PAD) Followed by High Dose Therapy and Peripheral Blood Stem Cell Transplantation in First-Line Treatment of T(4;14) Multiple Myeloma : a Prospective Study of the MAG Group.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3408-3408
Author(s):  
Lionel Karlin ◽  
David Ghez ◽  
Marie-Olivia Chandesris ◽  
Sylvain Choquet ◽  
Margaret Macro ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Partial Response ◽  
Peripheral Blood Stem Cell ◽  
Induction Treatment ◽  
High Dose ◽  
High Dose Therapy ◽  
Free Survival ◽  
Blood Stem Cell Transplantation

Abstract Abstract 3408 Poster Board III-296 The t(4;14)(p16.3;q32), leading to the ectopic expression of two potential oncogenes, the Multiple Myeloma Set Gene (MMSET) and the Fibroblast Growth Factor 3 (FGFR3), is found in 15% of patients with multiple myeloma (MM) and is associated with a very poor prognosis. We previously shown in patients under 65 years of age that High Dose Therapy followed by Peripheral Blood Stem Cell Transplantation (HDT-PBSCT) provides a high response rate (RR) but a very short median relapse-free survival of only 11 months. In addition, relapses are often aggressive and chemoresistant. Thus, more effective regimen is urgently needed. We prospectively studied 23 t(4;14) MM patients treated with 3 or 4 cycles of a combination of Bortezomib and Dexamethasone (VD) (n=4) or of Bortezomib, Adriamycine and Dexamethasone (PAD) (n=19) as induction treatment before HDT-PBSCT (Melphalan 200 mg/m2). T(4;14) was detected using real time quantitative PCR searching for IGH/MMSET and FGFR3 transcripts. RR, event-free survival (EFS) and overall survival (OS) were evaluated. Median age at diagnosis was 51 years (range, 33-64). Isotype was IgA in 12 (52%) patients. All patients had stage II or III MM. An elevated serum β2m level (>3.5 mg/L) was found in 14 (61%) patients, and a low haemoglobin (Hb) level (<10 g/dL) in 10. Four presented with renal failure and 5 with hypercalcemia. Three (16%) of 19 patients had a t(4;14) without expression of FGFR3. After induction treatment with VD or PAD, PBSC were successfully harvested with granulocyte-colony stimulating factor only (n=15) or following a cycle of high-dose cyclophosphamide (n= 7). RR after induction treatment was complete response (CR) in 6 (26%) patients, very good partial response (VGPR) in 9 (39%), partial response (PR) in 3. Five patients had refractory or progressive disease (PD), including 1 who died before stem cell mobilization. RR after HDT was CR in 11 (48%), VGPR in 4 (17%) and PR in 4 (overall RR of 82%). Three had PD. With a median follow-up of 18 months (range, 3-32), 9 (39%) patients are alive without relapse, including 4 with a 19, 27, 30 and 32 months follow-up respectively. Twelve (52%) patients relapsed. Two patients died in the first month post HDT from PD. We found a median EFS and OS from initiation of therapy of 14.7 and 30.9 months respectively. EFS was not influenced by Hb and/or serum β2m level. However, we found a significantly longer OS in patients with low β2m (median non reached) as compared to patients with high β2m (median=23.1 months, p=0.04). These preliminary results illustrate the heterogeneity of this disease and indicate that some t(4;14) MM patients seem to benefit from bortezomib containing regimen as induction treatment before HDT in term of EFS and OS. A larger series with a longer median time of follow up will be presented. Disclosures: No relevant conflicts of interest to declare.

Idiotype Vaccination Using Dendritic Cells After Autologous Peripheral Blood Stem Cell Transplantation for Multiple Myeloma—A Feasibility Study

Blood ◽  
1999 ◽  
Vol 93 (7) ◽  
pp. 2411-2419 ◽  
Author(s):  
Volker L. Reichardt ◽  
Craig Y. Okada ◽  
Arcangelo Liso ◽  
Claudia J. Benike ◽  
Keith E. Stockerl-Goldstein ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Immune Response ◽  
Dendritic Cells ◽  
Stem Cell ◽  
Immune Responses ◽  
Peripheral Blood Stem Cell ◽  
High Dose ◽  
High Dose Therapy ◽  
Dose Therapy ◽  
Blood Stem Cell Transplantation

The idiotype (Id) determinant on the multiple myeloma (MM) protein can be regarded as a tumor-specific marker. Immunotherapy directed at the MM Id may stem the progression of this disease. We report here on the first 12 MM patients treated at our institution with high-dose therapy and peripheral blood stem cell transplantation (PBSCT) followed by Id immunizations. MM patients received PBSCT to eradicate the majority of the disease. PBSCT produced a complete response in 2 patients, a partial response in 9 patients and stable disease in 1 patient. Three to 7 months after high-dose therapy, patients received a series of monthly immunizations that consisted of two intravenous infusions of Id-pulsed autologous dendritic cells (DC) followed by five subcutaneous boosts of Id/keyhole limpet hemocyanin (KLH) administered with adjuvant. Between 1 and 11 × 106 DC were obtained by leukapheresis in all patients even after PBSCT. The administration of Id-pulsed DC and Id/KLH vaccines were well tolerated with patients experiencing only minor and transient side effects. Two of 12 patients developed an Id-specific, cellular proliferative immune response and one of three patients studied developed a transient but Id-specific cytotoxic T-cell (CTL) response. Eleven of the 12 patients generated strong KLH-specific cellular proliferative immune responses showing the patients’ immunocompetence at the time of vaccination. The two patients who developed a cellular Id-specific immune response remain in complete remission. Of the 12 treated patients, 9 are currently alive after autologous transplantation with a minimum follow-up of 16 months, 2 patients died because of recurrent MM and 1 patient succumbed to acute leukemia. These studies show that patients make strong anti-KLH responses despite recent high-dose therapy and that DC-based Id vaccination is feasible after PBSCT and can induce Id-specific T-cell responses. Further vaccine development is necessary to increase the proportion of patients that make Id-specific immune responses. The clinical benefits of Id vaccination in MM remain to be determined.

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