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Effect of melphalan 140 mg/m 2 vs 200 mg/m 2 on toxicities and outcomes in multiple myeloma patients undergoing single autologous stem cell transplantation—a single center experience
Author(s) -
Katragadda Lakshmikanth,
McCullough Lindsay M.,
Dai Yunfeng,
Hsu Jack,
Byrne Michael,
Hiemenz John,
May Stratford,
Cogle Christopher R.,
Norkin Maxim,
Brown Randy A.,
Wingard John R.,
Chang Myron,
Moreb Jan S.
Publication year - 2016
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12762
Subject(s) - medicine , melphalan , multiple myeloma , autologous stem cell transplantation , proportional hazards model , regimen , transplantation , surgery , urology , hematopoietic stem cell transplantation , oncology , gastroenterology
Although melphalan at a dose of 140 mg/m 2 (MEL140) is an acceptable conditioning regimen for autologous stem cell transplantation (ASCT) in multiple myeloma (MM) patients, very few studies compared it to the most commonly used dose of 200 mg/m 2 (MEL200). A retrospective review of records of MM patients (2001–2010) identified 33 patients who received MEL140 and 96 patients who received MEL200. As expected, significantly higher percentage of patients in the MEL140 arm were >65 years or had cardiac ejection fraction <50%, had Karnofsky score <80, or had creatinine >2 at the time of ASCT ( P ≤.01). There were no significant differences in incidence of treatment related mortality and morbidity. At a median follow‐up of 74 months from ASCT, there were no significant differences in relapse free survival (RFS) and overall survival (OS) between the two groups. Similar proportion had myeloma status improve to ≥VGPR at 3 months post‐ASCT. Usage of post‐ASCT maintenance was similar. In multivariate cox proportional hazards model, only disease status of ≥VGPR at the time of ASCT significantly improved RFS ( P =.024), but not OS ( P =.104). In conclusion, MM patients who received MEL140 had similar long‐term outcomes to MEL200 patients despite their older age and co‐morbidities.