HIGH-DOSE MELPHALAN WITH RE-INFUSION OF UNPROCESSED, G-CSF-PRIMED WHOLE-BLOOD IS EFFECTIVE AND NONTOXIC THERAPY IN MULTIPLE-MYELOMA

In order to shorten the pancytopenic period following high-dose melpha lan 140 mg/m(2) (HDM) treatment of multiple myeloma patients, we studi ed the effects of re-infusing granulocyte colony stimulating factor (G -CSF) [Filgrastim, Neupogen(R)]-primed unprocessed whole blood. 30 pat ients with multiple myeloma were treated with HDM. One litre of blood after 5 or 6 days stimulation with G-CSF (10 mu g/kg) was drawn, kept unprocessed for 1 day and re-infused 24 h after chemotherapy. Time to granulocyte recovery (> 0.5 x 10(9)/l) and platelet recovery (> 20 x 1 0(9)/l) were assessed as well as length of hospital stay, number of tr ansfusions and antibiotic use. These 30 patients were compared with 20 historical control patients who were similarly treated but without st em cell support. The response rate was 75% (21/28) including a complet e remission (CR) rate of 29% (8/28). Two early deaths due to Aspergill us pneumonia were observed. The median overall survival after HDM has not been reached after a median follow-up of 14 months. 10 patients sh owed progression at a median of 7 months. Currently, 23 patients are a live with a median follow-up time of 14 months. Haematological recover y was significantly faster in the study group as compared to the histo rical control group. The neutrophil count reached 0.5 x 10(9)/l at a m edian of 14 days after infusion of 1 litre of unprocessed whole blood compared with 38 days in the historical control group. A platelet coun t of 20 x 10(9)/l was reached at a median of 26 days compared with 36 days in the historical control group. Length of hospital stay decrease d from a median of 43 to 18.5 days. The number of days with antibiotic s was reduced from a median of 21 to 6 days. HDM, is effective therapy for multiple myeloma. Toxicity of the regimen is considerably reduced by the use of G-CSF-stimulated unprocessed whole blood, an easy to pe rform and cheap technique to mobilise and collect stem cells. Copyrigh t (C) 1996 Elsevier Science Ltd