THE VALUE OF IFOSFAMIDE IN THE TREATMENT OF MULTIPLE-MYELOMA

Primary high-dose therapy with autologous peripheral blood progenitor cell (PBPC) reinfusion for advanced multiple myeloma (MM) appears supe rior to classic conventional chemotherapy with alkylators and corticos teroids. Long term conventional therapy with the standard alkylating a gent melphalan critically reduces the PBPC pool. Moreover. cases of hi ghly proliferative MM respond less readily to melphalan than to a comb ination of other alkylating agent?;. Oxazaphosphorines like ifosfamide (IFO), either as single agent or in combination with other drugs show satisfactory response rates without jeopardising the PBPC reserve. IF O-containing combinations as primary induction treatment show reliable PBPC mobilising potency (median 6.1x10(6) CD34 positive PBPC in a med ian of 2.5 leucaphereses), leucocytes Combination with epirubicin and dexamethasone leads to response rates equivalent to infusional protoco ls (67.2% CR and PR according to MRC criteria: median paraprotein redu ction to 27% of the initial value) even in melphalan-pretreated patien ts. The tubulo-toxic effect of IFO in patients with compromised renal function is rare and reversible, allowing the use of this agent in 66 out of 69 patients eligible for autologous transplant in our series. A part from this, IFO at doses up to and beyond 6 g/m(2) appears to be a n effective and nontoxic component of induction PBPC mobilising treatm ent in MM.