INTENSIVE CHEMOTHERAPY WITH BLOOD PROGENITOR TRANSPLANTATION FOR PRIMARY RESISTANT MULTIPLE-MYELOMA

This study assessed the feasibility and effect of blood progenitors as the only source of haemopoietic support for myeloablative therapy for patients with primary resistant multiple myeloma and markedly infiltr ated bone marrow. 17 patients with advanced, primary resistant myeloma received a priming regimen of cyclophosphamide (3 g/m(2)) and etoposi de (900 mg/m(2)) with GM-CSF. During haematological recovery, at least 2 x 10(6) CD34(+) mononuclear cells/kg were collected from each patie nt with 4-12 leukaphereses. High-dose chemotherapy was then given whic h consisted of thiotepa (750 mg/m(2)), busulfan (10 mg/kg) and cycloph osphamide (120 mg/kg) followed by reinfusion of the brood progenitors. Haemopoietic reconstitution was rapid with recovery of granulocytes t o > 1.0 x 10(9)/l after a median of 10 d and of platelets to 50 x 10(9 )/l after a median of 29 d. The myeloma responded in 10/17 patients fo r a projected median duration of at least 12 months. Survival was prol onged significantly in comparison with the outcome of control patients who did not receive intensive treatment. Blood progenitors, assessed from the number of CD34(+) cells, produced early haemopoietic recovery after myeloablative therapy that induced sustained control of advance d and resistant multiple myeloma.