CYCLOPHOSPHAMIDE (3.6 G M(2)) THERAPY WITH G-CSF SUPPORT FOR RESISTANT MYELOMA/

Background. In myeloma patients resistance to both melphalan- and doxo rubicin-containing regimens has been related to very short survival (a pproximately 6 months). The development of effective regimens combined with a low toxicity rate is mandatory in this patient subgroup. Metho ds. Fourteen resistant myeloma patients were treated with cyclophospha mide (a total of 3.6 g/m(2) was delivered in 2 doses on days 1 and 3) and prednisone (2 mg/kg, days 1-4) every month for 4 cycles. G-CSF sup port was administered to reduce myelosuppression. Results. This combin ation was well tolerated. Granulocyte levels fell below 0.1x10(9)/L in all patients after a median of 9 days (range 8-11), followed by recov ery to 0.5 x 10(9)/L after a median of 12 days from the start of treat ment (range 10-13 days). Platelets never fell below 50x10(9)/L. Ah pat ients were treated on an outpatient basis and only 2 required hospital ization for major complications (pneumonia and heart failure). Respons e to cyclophosphamide was observed in 6/14 patients: 2 achieved comple te remission, 4 showed a 50% or greater reduction of the M-component. Five patients are still in remission after 2, 6, 7, 9 and 10 months; 1 relapsed after 10 months. Ah patients except one are alive 4-16 month s from the start of treatment. Conclusions. This schedule may represen t a new approach for resistant myeloma, and its very low toxicity allo ws it to be delivered on an outpatient basis.