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Ferrero D, Bonello F, Oliva S, Gay F, Boccadoro M. Can the dismal prognosis of patients with central nervous system plasma cell neoplasms be improved? Leuk Res 2021; 107:106592. [PMID: 33933932 DOI: 10.1016/j.leukres.2021.106592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/19/2021] [Accepted: 04/06/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Dario Ferrero
- Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.
| | - Francesca Bonello
- Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Stefania Oliva
- Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesca Gay
- Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Mario Boccadoro
- Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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Fiala MA, Vosuri V, Goldsmith S, Schroeder MA, Ghobadi A, Wildes TM, Stockerl-Goldstein KE, Vij R. Maintenance therapy following salvage autologous stem cell transplant in patients with multiple myeloma. Bone Marrow Transplant 2019; 55:1188-1190. [PMID: 31462683 DOI: 10.1038/s41409-019-0663-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/08/2019] [Accepted: 07/25/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Mark A Fiala
- Washington University School of Medicine, St Louis, MO, USA
| | - Venkata Vosuri
- Washington University School of Medicine, St Louis, MO, USA
| | | | | | - Armin Ghobadi
- Washington University School of Medicine, St Louis, MO, USA
| | - Tanya M Wildes
- Washington University School of Medicine, St Louis, MO, USA
| | | | - Ravi Vij
- Washington University School of Medicine, St Louis, MO, USA.
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Barta SK, Jain R, Mazumder A, Carter J, Almanzar L, Browne R, Shahnaz S, Elkind R, Kaminetzky D, Battini R, Derman O, Kornblum N, Verma A, Braunschweig I. Pharmacokinetics-directed Intravenous Busulfan Combined With High-dose Melphalan and Bortezomib as a Conditioning Regimen for Patients With Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:650-657. [PMID: 28684379 DOI: 10.1016/j.clml.2017.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/24/2017] [Accepted: 06/08/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) has a well-established role in the treatment of patients with multiple myeloma. Melphalan 200 mg/m2 (Mel200) is the most commonly used preparative regimen. Several studies have provided evidence for potential synergism and safety when combining bortezomib (Btz) or busulfan (Bu) with melphalan (Mel). PATIENTS AND METHODS We conducted a prospective phase II study to investigate the safety and efficacy of conditioning with pharmacokinetics (PK)-directed intravenous (IV) Bu with Btz and Mel. Bu dosing was adjusted to target a total area under the curve (AUC) of 20,000 μM × min. Patients received Btz (1 mg/m2 × 4 doses) and Mel (140 mg/m2). RESULTS A total of 19 subjects were enrolled. Their median age was 55 years, and the median follow-up period was 23.7 months. PK testing resulted in 86% of patients achieving an estimated total AUC of 20,000 ± 2500 μM × min. The overall response rate (ORR) at day +100 after ASCT was 100% in the evaluable patients, with 11% of patients achieving a complete response. The 2-year progression-free survival rate was 57.9% (95% confidence interval [CI], 38%-89%), and the 2-year overall survival rate was 88.5% (95% CI, 76%-100%). The most common grade 3 and 4 toxicities were febrile neutropenia, dysphagia/odynophagia, and oral mucositis. No case of hepatic sinusoidal obstruction syndrome developed. One treatment-related mortality occurred before day +100. CONCLUSION A preparative regimen of PK-directed IV Bu with Btz and Mel led to an ORR of 100% with acceptable toxicity and should be considered for direct comparison with the Mel200 regimen in future trials.
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Affiliation(s)
- Stefan K Barta
- Fox Chase Cancer Center, Philadelphia, PA; Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY.
| | - Rishi Jain
- Fox Chase Cancer Center, Philadelphia, PA; Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY
| | - Amithaba Mazumder
- NYU Clinical Cancer Institute, New York, NY; Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Jason Carter
- Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY; Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Roy Browne
- Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY
| | | | - Richard Elkind
- Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY
| | | | | | - Olga Derman
- Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY
| | - Noah Kornblum
- Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY
| | - Amit Verma
- Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY
| | - Ira Braunschweig
- Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY
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Musso M, Messina G, Marcacci G, Crescimanno A, Console G, Donnarumma D, Scalone R, Pinto A, Martino M. High-Dose Melphalan Plus Thiotepa as Conditioning Regimen before Second Autologous Stem Cell Transplantation for “De Novo” Multiple Myeloma Patients: A Phase II Study. Biol Blood Marrow Transplant 2015; 21:1932-8. [DOI: 10.1016/j.bbmt.2015.06.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/12/2015] [Indexed: 12/12/2022]
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BEAM Conditioning Regimen Has Higher Toxicity Compared With High-Dose Melphalan for Salvage Autologous Hematopoietic Stem Cell Transplantation in Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:531-5. [PMID: 26166312 DOI: 10.1016/j.clml.2015.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/15/2015] [Accepted: 05/29/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Salvage autologous stem cell transplantation (ASCT) is increasingly used for eligible patients with multiple myeloma (MM) for progress after conventional chemotherapy. We recently used BEAM (BCNU, etoposide, cytarabine, and melphalan) conditioning for patients with myeloma receiving salvage ASCT whose disease progressed after a first ASCT with high-dose melphalan (HDM). We report safety and efficacy of BEAM salvage ASCT in MM in comparison with HDM-based salvage ASCT. PATIENTS AND METHODS Between 2008 and 2013, 43 consecutive patients received salvage ASCT for MM (19 with HDM; 24 with BEAM). RESULTS The BEAM group had a higher incidence of infections, intensive level of care, and fever (19 vs. 13 patients; P = .02), whereas the melphalan group had a higher incidence of mucositis (7 vs. 2 patients; P = .03). Other toxicities were not different. There was no significant difference in disease status and response rate before and after salvage ASCT between the 2 groups. The median time of follow-up after salvage ASCT was 5 and 9 months and the median progression-free survival (PFS) times were 7.7 and 12.1 months (P = .82) for BEAM and melphalan, respectively. CONCLUSION BEAM seemed to be associated with higher toxicity with comparable efficacy to HDM ASCT. Longer follow-up is needed to determine whether there is any significant difference in PFS between the 2 groups.
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