Melphalan 220 mg/m(2) followed by peripheral blood stem cell transplantation in 27 patients with advanced multiple myeloma

Twenty-seven patients with advanced multiple myeloma received high-dose the rapy with 220 mg/m(2) i.v. melphalan (HDM220) followed by autologous stem c ell transplantation. At the time of HDM220, nine patients had primary refra ctory disease and 18 were in relapse after having responded to prior high-d ose therapy. No toxic deaths were observed. The major adverse side-effect w as grade 4 mucositis in 63% of patients. Two patients experienced reversibl e paroxysmal atrial fibrillation after HDM220, For the whole group of patie nts, the actuarial 3-year overall survival (OS) and event-free survival (EF S) are 36.1 and 16.9%, respectively. The probability of OS and EFS was sign ificantly lower in patients treated for refractory relapse (22.9 and 0% at 2 years, respectively) as compared to primary refractory patients (66.7 and 64.3% at 2 years, respectively) or patients treated for chemosensitive rel apse (42.9% at 2 years) (P = 0.0001). Low beta 2-microglobulin and CRP leve ls at the time of HDM220 were associated with a better OS and EFS, Our data suggest that HDM220 followed by ASCT should be considered in patients with primary refractory disease or chemosensitive disease relapsing after prior intensive therapy.