Vojnosanitetski pregled 2011 Volume 68, Issue 5, Pages: 387-392
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Autologous stem cell transplantation in the treatment of multiple myeloma single center experience
Marjanović Slobodan, Stamatović Dragana, Tukić Ljiljana, Tarabar Olivera, Elez Marija, Mađaru Lavinika, Balint Bela, Tatomirović Željka, Kuljić-Kapulica Nada, Anđelković Nebojša
Background/Aim. In comparison to standard therapy autologous stem cell
transplant (ASCT) with high doses melphalane has improved treatment of
multiple myeloma (MM) patients. The aim of this study was to evaluate the
results of treatment of MM patients in our center with ASCT conditioning with
melphalane or combining busulphane, cyclophosphamide and melphalane. Methods.
We performed 62 ASCT procedures in 47 patients from 1998 till 2008. Single
ASCT were performed in 32 patients (68%), after 3-6 cycles of vincristine,
adriamycin, dexamethasone (VAD) protocol and double in 9 patients (19%).
Secondary ASCT was performed in 6 (13%) patients during progression of the
disease after single ASCT. Mobilization of stem cells (SC) was either with a
combination of etoposide and cyclophosphamide with granulocyte
colony-stimulating factor (G-CSF) in 39 (83%) patients or cyclophosphamide
plus G-CSF in 8 (17%) patients. All the patients received G-CSF five days
after the ASCT and maintenance therapy afterwards in the patients with a
complete remission (CR) or a partial remission (PR) was interferon alpha in
14 (30%) patients, thalidomide in 13 (28%) and others in 12 (26%) patients.
Results. Median engraftment was on 12th day. In a 50-month follow-up period
64% patients were alive. The overall response rate (ORR), which was reached in
38 (80%) patients, was better in the group of patients treated in the early
phase of MM. Totally 25 (53%) patients were without progression in a 25-month
follow-up period. Twenty patients met criteria for CR + VGPR (very good
partial remission), that was 5 patients more than in the period before ASCT.
Fourteen (30%) patients died and median time till death was 17 months.
Conclusion. The ASCT perfomed in early phase of MM after VAD induction had a
significant influence on the treatment of MM patients. Reaching CR + VGPR
before and after the ASCT is predictive factor for overall survival (OS) or
prolongation of period till recidive appears, progression, therapy withdrowal
Keywords: multiple myeloma, antineoplastic combined chemotherapy protocols, transplantation, autologous, stem cells, survival analysis
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