29 patients with Stage III multiple myeloma have undergone transplantation at our institution over the past 10 years. Patient selection criteria included age less than 70 years, creatinine less than 2mg/ml, no active infection, cardiac ejection fraction >40%, DLCO > 50% of predicted and no other co-morbid conditions that would jeopardize sur-vival. In addition, there was demonstrated chemo-sensitivity of the disease with at least a 50% decrease in M-component and a decrease in marrow plasmacytosis to less than 10%. After treatment to maximal effect with VAD (3–6 cycles), peripheral blood stem cells were collected. The dose of CD34 positive cells ranged from 1.8 to 17.4 x106/kg. (median 11.4 x 106/kg). 8 patients treated prior to September 2000 received high dose therapy with Melphalan 140mg/m2 and fractionated TBI, 150cGy bid for 5 doses. Patients treated after September 2000 received Melphalan 200mg/m2 without radiation. The median age at transplantation was 52 years (range 29 to 71). There were no treatment related deaths. Days to achieve AGC>500/ul ranged from 5 to 13 (average 6.8). The median length of follow up is 2.7 years. Currently 23 patients are alive, and 18 are free from progression. Overall survival at 5 years is 79%. Progression-free survival at 5 years is 43%.

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Our experience suggests that carefully selected patients with chemo-responsive multiple myeloma have relatively high rates of overall and progression free survival when compared to results reported for a broader population of patients.

Topics:
autologous stem cell transplant, chemotherapy regimen, multiple myeloma, plasmacytosis, melphalan, transplantation, carbon monoxide diffusing capacity test, cd34 antigens, creatinine, follow-up

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2005, The American Society of Hematology
2005
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