Bridging advanced myeloma patients to subsequent treatments and clinical trials with classical chemotherapy and stem cell support.
Tarek H MouhieddineErin MoshierSantiago ThibaudBenjamin PuliafitoMohammad RattuRita JakubowskiLarysa SanchezAdriana RossiCesar RodriguezShambavi RichardHearn Jay ChoSamir ParekhAjai ChariAmir SteinbergJoshua RichterPublished in: Bone marrow transplantation (2022)
Rapidly progressing relapsed/refractory multiple myeloma (RRMM) patients with compromised marrow have limited treatment options. Thus, non-myeloablative chemotherapy with a stem cell boost (SCB) may provide disease control and hematopoietic improvement as bridge to subsequent therapies. We identified 96 patients who received a SCB between January 2011 and December 2019 at the Mount Sinai Hospital. Patients had a median age of 64 years, received a median of 7 prior lines of therapy and 68 and 42% were triple-class and penta-drug refractory, respectively. Chemotherapy included melphalan (MEL) (n = 16), melphalan + carmustine (BCNU/MEL) (n = 52) or a variant of DCEP (dexamethasone, cyclophosphamide, etoposide, cisplatin) (n = 28). Median time to neutrophil recovery was 10 days and was significantly lower with DCEP (8 days) compared to MEL and BCNU/MEL (10-11 days) (p = 0.0047). Time to progression, progression-free survival and overall survival were 3.19, 2.7 and 8.38 months, respectively. The BCNU/MEL group had the highest response rate of 85% (p = 0.05), clinical benefit rate of 94% (p = 0.0014), progression-free survival of 3.3 months (p = 0.4) and overall survival of 8.7 months (p = 0.5). Sixty-six patients (69%) were bridged to new lines of therapy, including clinical trials. Non-myeloablative chemotherapy with SCB provides rapid disease control and marrow recovery with potential to receive further therapy.
Keyphrases
- free survival
- stem cells
- clinical trial
- newly diagnosed
- end stage renal disease
- multiple myeloma
- ejection fraction
- high dose
- peritoneal dialysis
- locally advanced
- low dose
- squamous cell carcinoma
- prognostic factors
- emergency department
- patient reported outcomes
- acute lymphoblastic leukemia
- risk assessment
- radiation therapy
- mesenchymal stem cells
- phase ii
- diffuse large b cell lymphoma
- open label
- adverse drug
- drug induced
- human health