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Treatment of aggressive multiple myeloma by high-dose chemotherapy and
total body irradiation followed by blood stem cells autologous graft
JP Fermand, Y Levy, J Gerota, M Benbunan, JM Cosset, S Castaigne, M Seligmann and JC Brouet
Service d'Hematologie et d'Immunohematologie, Hopital Saint-Louis, Paris,
France.
Eight patients with stage III aggressive multiple myeloma, refractory to
current chemotherapy in six cases, were treated by high-dose chemotherapy
(nitrosourea, etoposide, and melphalan) (HDC) and total body irradiation
(TBI), followed by autografting with blood stem cells. These cells were
previously collected by leukapheresis performed during hematologic recovery
following cytotoxic drug-induced bone marrow aplasia. Seven patients were
alive 9 to 17 months after HDC-TBI and graft. One died at day 40 from
cerebral bleeding. All living patients achieved a 90% or greater reduction
in tumor mass. In two cases, a complete remission (CR) has persisted at a
follow-up of 15 and 16 months. Three patients have been well and off
therapy with stable minimal residual disease (RD) since 10, 11, and 17
months, respectively. A patient in apparent CR and another with RD have
relapsed 9 to 12 months posttreatment. Autologous blood-derived
hematopoietic stem cells induced successful and sustained engraftment in
all living patients. These results, although still preliminary, indicate
that HDC and TBI, followed by blood stem cells autograft, which has both
practical and theoretical interest over allogeneic or autologous bone
marrow transplantation, deserve consideration in selected patients with
multiple myeloma.
Volume 73,
Issue 1,
pp. 20-23,
01/01/1989
Copyright © 1989 by The American Society of Hematology
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