scholarly journals Darbepoietin-Alfa after High-Dose Melphalan and Autologous Hemopoietic Progenitor Cell in Multiple Myeloma Patients: A Pilot Study

2012 ◽  
Vol 02 (03) ◽  
pp. 59-65
Author(s):  
Massimo Martino ◽  
Ida Callea ◽  
Tiziana Moscato ◽  
Antonella Pontari ◽  
Elisa Spiniello ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Pilot Study ◽  
Progenitor Cell ◽  
High Dose ◽  
High Dose Melphalan ◽  
Hemopoietic Progenitor

r-HuEPO 40,000 U one time/week before high-dose melphalan allows a tandem autologous peripheral stem-cell transplantation without red blood cell transfusion in multiple myeloma patients: A pilot study

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 7103-7103
Author(s):  
M. V. Martino ◽  
G. Console ◽  
E. Massara ◽  
T. Moscato ◽  
I. Callea ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Pilot Study ◽  
Stem Cell Transplantation ◽  
Blood Cell ◽  
Induction Chemotherapy ◽  
High Dose ◽  
Transfusion Requirements ◽  
High Dose Melphalan ◽  
Rbc Transfusion

7103 Purpose: To decrease red blood cell (RBC) transfusion requirements during a tandem high-dose melphalan (HDM) for multiple myeloma (MM) patients (PTS), we conducted a pilot study to assess the effect of high-dose of recombinant human erythropoietin (rHuEpo) started during chemotherapy before the first HDM and autologous peripheral blood stem-cell transplantation (APBSCT). Patients and Methods: After induction chemotherapy with VAD, 14 consecutive PTS with MM, stage III, median age 58 years (range 42–62), were mobilized with cyclophosphamide (3–4 g/m2) to collect peripheral blood stem cells (PBSC) and entered a study consisting of two HDM (200 mg/m2) with APBSCT. Enrolled patients received rHuEpo (40,000 U subcutaneously one time/week) as soon as their hemoglobin (Hb) level fell <11 g/dl during induction chemotherapy. rHuEpo was continued at the same dose during PBSC collection and was reintroduced at the time of discharge after the first transplant up to the admission for the second one. If the Hb level exceeded 13 g/dl at any time, rHuEpo was withheld until the concentration decreased to <11 g/dl, at which time it was restarted. Results were compared to those of 20 tandem HDM and APBSCT performed in 15 consecutive historical MM controls matched for hematological parameters. Results: rHuEpo increased the hemoglobin (Hb) level from 10.1 ± 2.5 g/dl at diagnosis to 12.8 ± 2 g/dl at the time of the first HDM; no major adverse effects occurred. Compared to historical controls (46.6%, 7/15), RBC transfusion requirements were significantly lower for rHuEpo recipients (6.6%, 1/14) (P=0.00001). After the tandem HDM and APSCT, fewer RBC transfusions were needed: 3.3 and 1 RBC units for controls and rHuEpo recipients, respectively (P=0.006). Conclusion: The administration of high dose of rHuEpo during induction chemotherapy and interval beetween the first and second HDM cycle permit the realitazion of tandem chemotherapic program with a reduction of blood product support. No significant financial relationships to disclose.

At-Home Management of Aplastic Phase Following High-Dose Melphalan and Autologous Haematopoietic Stem Cell Transplantation for Multiple Myeloma Patients: A Pilot Study

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4497-4497
Author(s):  
Massimo Martino ◽  
Grazia Pellicano’ ◽  
Tiziana Moscato ◽  
Elisabetta Massara ◽  
Roberta Fedele ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Pilot Study ◽  
Stem Cell Transplantation ◽  
Home Care ◽  
Supportive Care ◽  
High Dose ◽  
Hospital Beds ◽  
High Dose Melphalan ◽  
At Home

Abstract Abstract 4497 BACKGROUND: After high-dose melphalan with autologous peripheral hematopoietic stem cell transplantation (APHSCT) long hospital stays in the aplastic phase are expensive, lead to increased risk of hospital infections and to increasing pressure on available hospital beds. AIM OF THE STUDY: The aim of this pilot study was to analyze the feasibility of a home care program (HCP) for Multiple Myeloma (MM) patients receiving high-dose melphalan 200 mg/mq (HDM), and undergoing APHSCT to be at home for the aplastic period, without daily hospital visits. PATIENTS AND METHODS: Between July 2010 and July 2011 supportive care in the aplastic phase after APHSCT was transferred from the hospital to the home setting. Eligible subjects included patients with de novo, symptomatic, MM treated with a single course of HDM, followed by APHSCT. In the home care cohort, patients were required to have an available caregiver at home to help monitor patient’s condition. In case of patient refusal or ineligible to the HCP treatment, these patients were registered in the inpatient cohort as the control arm. Patients were discharged to their private home the day after stem-cell reinfusion in the absence of the contraindications. Hospital transplant nursing staff, delivered all supportive care at home and this included blood sampling from the central indwelling intravenous catheter for laboratory investigations and cultures, transfusion of blood products, and infusion of parenteral antibiotics. The transplant physician carried out the survey to the home-patient twice a day, with no access to hospital. In case of unexpected problems, patients could consult the transplant physicians 24 hours a day at the transplant center. RESULTS: 39 consecutive MM patients were treated with HDM and AHSCT. 11 patients agreed to be managed during the aplastic phase at home; 28 patients were not eligible (4 did not have an available caregiver; 4 have not accepted the management at home; 20 patients lived more than 15 kilometers from the hospital). In the 11 transplant cycles in the home care cohort, patients were discharged on the first day after stem-cell reinfusion in all cases. The patients in the hospital cohort were hospitalized for a median of 18 days The home care patients spent most of the aplastic period at home, for a median of 12 days, with 4 days in hospital. Readmissions occurred in 2/11 of home care patients and were because of fever. Febrile neutropenia occurred for a median of 3 and 7 days in the aplastic period for patients in the hospital and home care setting respectively. Other side effects were mild and comparable between the two study groups. No transplant related mortality occurred in both cohort of patients. CONCLUSIONS: An HCP using HDM is feasible. No unexpected emergencies were encountered, and toxicity did not seem different from the full hospitalization schedule during the aplastic period. We have not had to compromise on patient safety and have gained on quality of life and improved the allocation of available hospital beds Disclosures: No relevant conflicts of interest to declare.

scholarly journals Busulfan plus melphalan versus melphalan alone conditioning regimen after bortezomib based triplet induction chemotherapy for patients with newly diagnosed multiple myeloma

2021 ◽  
Vol 12 ◽  
pp. 204062072110129
Author(s):  
Songyi Park ◽  
Dong-Yeop Shin ◽  
Junshik Hong ◽  
Inho Kim ◽  
Youngil Koh ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Induction Chemotherapy ◽  
Statistical Significance ◽  
Conditioning Regimen ◽  
Progression Free Survival ◽  
High Dose ◽  
Newly Diagnosed ◽  
Cell Engraftment ◽  
The Difference ◽  
High Dose Melphalan

Background: High dose melphalan (HDMEL) is considered the standard conditioning regimen for autologous stem cell transplantation (ASCT) in multiple myeloma (MM) patients. Recent studies showed superiority of busulfan plus melphalan (BUMEL) compared to HDMEL as a conditioning regimen. We compared the efficacy of HDMEL and BUMEL in newly diagnosed Asian MM patients, who are often underrepresented. Methods: This is a single-center, retrospective study including MM patients who underwent ASCT after bortezomib-thalidomide-dexamethasone (VTD) triplet induction chemotherapy between January 2015 and August 2019. Result: In the end, 79 patients in the HDMEL group were compared to 31 patients in the BUMEL group. There were no differences between the two groups with regards to sex, age at ASCT, risk group, and stage. The HDMEL group showed better response to pre-transplant VTD compared to BUMEL, but after ASCT the BUMEL group showed better overall response. In terms of progression-free survival (PFS), although BUMEL showed trends towards better PFS regardless of pre-transplant status and age, the difference did not reach statistical significance. The BUMEL group more often experienced mucositis related to chemotherapy, but there was no difference between the two groups with regards to hospitalization days, cell engraftment, and infection rates. Conclusion: BUMEL conditioning deserves attention as the alternative option to HDMEL for newly diagnosed MM patients, even in the era of triplet induction chemotherapy. Specifically, patients achieving very good partial response (VGPR) or better response with triplet induction chemotherapy might benefit the most from BUMEL conditioning. Tailored conditioning regimen, based on patient’s response to induction chemotherapy and co-morbidities, can lead to better treatment outcomes.

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