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Prognostic factors with high-dose melphalan for refractory multiple myeloma
[see comments]
B Barlogie, R Alexanian, L Smallwood, B Cheson, D Dixon, K Dicke and F Cabanillas
Department of Hematology, University of Texas M.D. Anderson Cancer Center,
Houston.
High doses of melphalan (HDM) and dexamethasone were administered to 43
patients with advanced multiple myeloma, 36 of whom were refractory to both
standard melphalan-prednisone and vincristine-adriamycin- dexamethasone
(VAD). Forty-four percent responded with greater than 75% reduction in
calculated tumor mass, including three patients who achieved a complete
remission. The response rate to HDM was 56% in 18 relapsing patients and
50% in 12 patients with less than 12 months of primary drug resistance, but
it was only 23% among the remaining 13 unresponsive patients. A high early
mortality rate of 30% was confined to 26 patients with either poor
performance (Zubrod greater than 1) or impaired renal function (creatinine
greater than 1.4 mg%). When this toxic treatment was given to the 21
patients with good performance (Zubrod less than 2) whose disease lacked
high serum lactic dehydrogenase (less than or equal to 500 U/L) as a
recently recognized feature of high-grade myeloma, a superior median
survival of 18 months was obtained as opposed to only 3 months for the 22
remaining patients (P less than .001). Thus, when employed in a timely
fashion, HDM overcomes resistance to standard chemotherapy and VAD and
benefits selected patients with advanced myeloma.
Volume 72,
Issue 6,
pp. 2015-2019,
12/01/1988
Copyright © 1988 by The American Society of Hematology
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