Total Therapy With Tandem Transplants for Newly Diagnosed Multiple Myeloma

作者：Bart Barlogie, Sundar Jagannath, K. Raman Desikan, Sharon Mattox, David H. Vesole, David Samuel DiCapua Siegel, Guido J. K. Tricot, Nikhil C. Munshi, Athanasios Fassas, Seema Singhal, Jayesh Mehta, E. Anaissie, D. Dhodapkar, Sally Naucke, Jeana Cromer, Jeffrey R. Sawyer, Joshua Epstein, Dan Spoon, Donald M. Ayers, Bruce D. Cheson, John Crowley · 发表于：Blood · 年份：1999 · DOI：10.1182/blood.v93.1.55.401k04_55_65 · 被引用次数：504 · 研究领域：Multiple Myeloma Research and Treatments、Peptidase Inhibition and Analysis、Cancer therapeutics and mechanisms

Between August 1990 and August 1995, 231 patients (median age 51, 53% Durie-Salmon stage III, median serum β-2-microglobulin 3.1 g/L, median C-reactive protein 4 g/L) with symptomatic multiple myeloma were enrolled in a program that used a series of induction regimens and two cycles of high-dose therapy (“Total Therapy”). Remission induction utilized non–cross-resistant regimens (vincristine-doxorubicin-dexamethasone [VAD], high-dose cyclophosphamide and granulocyte-macrophage colony-stimulating factor with peripheral blood stem cell collection, and etoposide-dexamethasone-cytarabine-cisplatin). The first high-dose treatment comprised melphalan 200 mg/m2 and was repeated if complete (CR) or partial (PR) remission was maintained after the first transplant; in case of less than PR, total body irradiation or cyclophosphamide was added. Interferon--2b maintenance was used after the second autotransplant. Fourteen patients with HLA-compatible donors underwent an allograft as their second high-dose therapy cycle. Eighty-eight percent completed induction therapy whereas first and second transplants were performed in 84% and 71% (the majority within 8 and 15 months, respectively). Eight patients (3%) died of toxicity during induction, and 2 (1%) and 6 (4%) during the two transplants. True CR and at least a PR (PR plus CR) were obtained in 5% (34%) after VAD, 15% (65%) at the end of induction, and 26% (75%) after the first and 41% (83%) after the second transplants (intent-to-treat)....