Hemibody irradiation. An effective second-line therapy in drug-resistance multiple myeloma

Half-Body Irradiation in the Treatment of Multiple Myeloma: A Report of Nine Cases

We report the results of treatment of 9 patients with advanced multiple myeloma (MM) using half-body irradiation. Six nonresponders to chemotherapy received it as consolidation therapy after the plateau phase of MM had been observed, and 4 patients received it as salvage therapy of refractory or relapsing MM. One of the patients received it twice, first as consolidation and later during the course of her disease also as salvage therapy. Objective response was obtained in 1 of 6 patients who received half-body irradiation as consolidation therapy and in 3 of 4 patients who received it as salvage therapy. Responders to half-body irradiation generally achieved a longer relapse-free interval. Treatment with half-body irradiation was especially effective in combination with human leukocyte interferon as salvage therapy in 2 of the patients with refractory MM, leading to a relapse-free interval of more than 27 months in one of them. Symptomatic relief was observed in 5 of 6 patients. All had transient post-irradiation pancytopenia, with pneumonitis, nausea and vomiting observed in those who had the upper half of the body irradiated first. It is thus our opinion that half-body irradiation should not be used as consolidation therapy in nonresponders to chemotherapy, because it causes undue toxicity to heavily pretreated patients. Its role in the treatment of refractory or relapsing MM in combination with human leukocyte interferon should be fully evaluated.

Treatment of hematologic malignancies with alternate hemibody irradiation combined with high-dose chemotherapy: a single-center experience

The objective of this study was to evaluate the clinical outcome of the treatment of hematologic malignancies with alternate hemibody irradiation (AHBI) combined with high-dose chemotherapy. Seventeen patients with hematologic malignancies were treated with AHBI combined with high-dose chemotherapy. Following high-dose chemotherapy, upper hemibody irradiation (UHBI) and lower hemibody irradiation (LHBI) were given sequentially in a dose of 6 to 9 Gy. UHBI was given 14 days (range, 12-22 days) after high-dose chemotherapy, and LHBI was performed 23 days (range, 7-34 days) after UHBI. Meanwhile, we treated a control group of 14 patients with acute lymphoblastic leukemia (ALL) with autologous hematopoietic stem cell transplantation (AHSCT). Hematopoietic reconstitution was observed in all of the patients. The median follow-up period was 927 days (range, 428-1446 days). The 3-year probabilities of disease-free survival (DFS) were 52.38% +/- 13.47% for the patients in complete remission who underwent AHBI. No patient died of AHBI-related toxicity. The 3-year DFS rates for the 2 groups of patients with ALL were not significantly different (47.73% +/- 17.55% in the AHBI group and 53.88% +/- 14.08% in the AHSCT group; P > .05). AHBI combined with high-dose chemotherapy is a feasible approach for patients with hematologic malignancies and has the advantages of a desirable effectiveness, low costs, simple operation, and acceptable side effects.

Malignancy: Myeloma - the Elusive Cure

Myeloma accounts for 1% of all malignancies and is characterised by the malignant expansion of plasma cells. It is essentially incurable with a median survival of 6 months untreated. Typically disseminated at presentation, myeloma requires systemic therapy, in those patients with advanced or progressive disease. Of single agent therapies, oral mephalan remains the gold standard, either alone or in combination with steroids. 40% will respond with an increase in median survival from under 1 year to around 36 months. Combination chemotherapy produces an advantage in remission induction but no clear benefit for either survival or remission duration has been shown over standard melphalan and prednisolone. Significant melphalan dose escalation produces increased response rates and increased complete remission rates, however at the expense of increased toxicity. This has been ameliorated to an extent using stem cell support, however, although autografting may be superior to conventional chemotherapy it is not a curative treatment and modifications such as purging or tandem procedures remain to be fully evaluated. Allogeneic transplantation is only an option in a tiny minority of patients and has a high treatment-related mortality. Interferon alpha may improve the relapse free survival but has little effect on overall survival as the majority of patients will relapse. Experimental approaches, such as P-gp inhibition or thalidomide, are appropriate in this poor prognosis group. In many patients palliative care remains the only therapeutic option and close attention should be therefore paid to the prevention and treatment of renal failure, anaemia, infection, hypercalcaemia and bone disease.

Double hemibody irradiation (DHBI) in the management of relapsed and primary chemoresistant multiple myeloma

In view of increasing controversy regarding the role of double hemibody irradiation (DHBI) in the treatment of multiple myeloma, we have analysed the use of this technique at our institution over a 6-year period. Fifty-five patients with multiple myeloma were treated with both upper and lower hemibody irradiation between January 1985 and January 1991; 42 had relapsed post-plateau and 13 were chemoresistant to initial therapy. Fifteen patients received alpha IFN-2b maintenance therapy post-DHBI, at a dose of 3 Mu three times per week, as part of a randomized trial. Ninety-five per cent of patients experienced symptomatic improvement in bone pain post-DHBI, 21% of whom discontinued opiate analgesics altogether; 63% had a minor biochemical response and 38% had a partial biochemical response. The overall survival (OS) and progression free survivals (PFS) in all patients were 11 months and 8 months respectively. No significant difference was noted in either OS or PFS, according to whether patients were chemoresistant or had relapsed post-plateau. alpha IFN did not appear to prolong survival (OS or PFS) post-DHBI. Cytopenia was a significant problem, such that only 60% of patients had counts adequate enough to be eligible for alpha IFN. We conclude that DHBI is an effective treatment in patients with relapsed multiple myeloma and in those who are chemoresistant to initial therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Prospective randomised study of double hemi-body irradiation with and without subsequent maintenance recombinant alpha 2b interferon on survival in patients with relapsed multiple myeloma

Immediately before first hemi-body irradiation, 59 patients with relapsed multiple myeloma were randomised to receive or not to receive subsequent alpha-2b interferon maintenance. 13 patients (22%) [8 of 31 (26%) controls, 5 of 28 (18%) in the interferon arm] received single hemi-body irradiation alone due to progressive disease and/or persistent cytopoenias following the initial procedure. Mean time between upper and lower hemi-body irradiation was 69 days (range 35-294). Of 23 patients randomised to receive interferon and completing double hemi-body irradiation, 15 (65%) achieved peripheral blood counts adequate to allow interferon administration as per study criteria commencing at a mean 116 days (61-241) from time of study entry. The mean period of interferon therapy, starting at a mean 65 days (26-160) post second hemi-body irradiation, is 16.4 months (2-33.5). There was no significant difference in median survival durations (10 months) from time of initial radiotherapy between control and interferon patients.