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The clinical outcome and toxicity of high‐dose chemotherapy and autologous stem cell transplantation in patients with myeloma or amyloid and severe renal impairment: a British society of blood and marrow transplantation study
Author(s) -
Bird Jennifer M.,
Fuge Rhian,
Sirohi Bhawna,
Apperley Jane F.,
Hunter Ann,
Snowden John,
Mahendra Premini,
Milligan Donald,
Byrne Jenny,
Littlewood Timothy,
Fegan Christopher,
McQuaker Grant,
Pagliuca Antonio,
Johnson Peter,
Rahemtulla Amin,
Morris Curly,
Marks David I.
Publication year - 2006
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.2006.06191.x
Subject(s) - medicine , melphalan , multiple myeloma , transplantation , al amyloidosis , surgery , dialysis , amyloidosis , chemotherapy , creatinine , autologous stem cell transplantation , toxicity , gastroenterology , immunology , antibody , immunoglobulin light chain
Summary The outcome of high‐dose chemotherapy (HDT) was evaluated retrospectively in 27 patients with myeloma and four patients with AL amyloidosis with severe renal impairment. Twenty‐three patients were receiving dialysis and the rest had a creatinine clearance of <20 ml/min. The median melphalan dose was 140 mg/m 2 (range: 60–200 mg/m 2 ), but 10 patients (37%) received 200 mg/m 2 . Myeloid and platelet engraftment were similar to that seen in patients without renal failure. Five of 27 patients died of transplant‐related toxicity before the day 100. Twenty of 27 patients had a response (70%). The median time to disease progression was 32 months (range: 6–54 months) and the median time to best response was 6·5 months. Four of 17 evaluable patients (24%) became dialysis‐independent at a median of 5 months post‐HDT/stem cell transplantation. At a median follow‐up of 70 months, 7/23 patients with myeloma were alive but three of these seven patients had progressive disease. Two of the four patients with amyloidosis have survived. HDT is feasible in these patients and results in 5‐year survival in about one‐third of patients.