Abstract
BACKGROUND: Melphalan is the most common conditioning regimen prior to autologous stem cell transplant in patients with Multiple Myeloma. Conventionally Melphalan was administered at a dose of 200mg/m2 for 2 days[100 mg/m2 each day] prior to transplantation on days -4 and -3 followed by autologous stem cell infusion on day 0. Recently we changed the scheduling of Melphalan to 200mg/m2 given on day-2 and stem cell infusion on day 0.
OBJECTIVE: A retrospective analysis was done to assess the effect of this change in Melphalan regimen on length of stay in hospital and gastrointestinal toxicity.
METHODS: We performed a retrospective analysis of 20 patients receiving melphalan as conditioning regimen prior to autologous stem cell transplant. All patients received similar induction therapy and were transplanted as part of their initial therapy. Assessment including maximum oral score per day of transplant (using the oral assessment guide developed by the University of Nebraska Medical Center) and number of days with nausea/vomiting/diarrhea were analyzed to compare gastrointestinal toxicity.
PATIENTS: Records on twenty patients with multiple myeloma undergoing autologous stem cell transplant from January 2003 until August 2006 were reviewed. Study population included10 females and 10 males. Average age was 60 yrs in melphalan 200mg/m2 over 2 days group and 55 in melphalan 200mg/m2 over one day group.
RESULTS: The average length of hospital stay was 17.4 days in the Melphalan 200mg/m2 over 2 days group and 15.4 days in the Melphalan 200 mg/m2 over 1 day group. The average number of days of reported nausea/vomiting and diarrhea was 7.1 in the Mel 200 mg/m2 over1 day and 7.6 days in the Mel 200mg/m2 over 2 day group. The average peak daily oral score in the Mel 200mg/m2 over 2 days was slightly higher (14 vs 12) and the duration of reported abnormal oral scores was slightly longer for the patients in the Mel 200mg/m2 over 1 day group (13 days vs. 10 days).
CONCLUSION: The major advantage of delivering Melphalan over one day as opposed to two days is decreased length of hospital stay and thereby the costs. However this does not appear to be at the expense of increased gastrointestinal toxicity. Although the duration of mucositis appears to be longer in the Melphalan 200mg/m2-1 day group, this did not lead to a prolonged length of stay in our patients. Reported nausea/vomiting/diarrhea was not significantly different in both groups.
