S. Hovenga et al., Autologous stem cell transplantation in multiple myeloma after VAD and EDAP courses: a high incidence of oligoclonal serum Igs post transplantation, BONE MAR TR, 25(7), 2000, pp. 723-728
Citations number
21
Categorie Soggetti
Hematology,"Medical Research Diagnosis & Treatment
Thirty-seven patients with multiple myeloma (stage II and III, 65% increase
d beta 2-microglobulin level) were prospectively treated with a median of 3
.7 VAD courses (range 2-8) followed by cyclophosphamide (6 g/m(2)) in conju
nction with G-CSF (5 mu g/kg filgrastrim (n = 14), or 3.5 mu g/kg lenograst
rim (n = 22)), and peripheral stem cell (PSC) isolation. After regeneration
this was followed by one EDAP course and high-dose melphalan (HDM, 200 mg/
m(2)) in combination with re-infusion of PSC, Adequate stem cell mobilizati
on was obtained with both G-CSF regimens. A median of 41 x 10(6) CD34(+) ce
lls/kg (range 4.5-161) was collected in a median of 1.6 leukapheresis proce
dures following filgrastrim (n = 14) and 24 x 10(6) CD34(+) cells/kg (range
2.3-80) in a median of 1.7 leukapheresis procedures following lenograstrim
(n = 22) which indicated no significant difference (P = 0.24) between both
G-CSF regimens. A rapid hematological recovery was obtained after HDM with
reinfusion of a median of 9.3 x 10(6) CD34(+) cells/kg, After the total co
urses the overall response was 84% with a complete remission rate of 30%, C
urrently the median overall survival is 44.0 months (95% CI 38.9-49.1) with
a median follow-up of 33 months (range 3-51) and a median event-free survi
val of 29.0 months (95% CI 25.3-32.7) (n = 33), Post transplantation a high
incidence of oligloclonal serum immunoglobulins (Igs) was observed. In 73%
of the patients new oligoclonal or monoclonal serum bands were noticed 3 m
onths post transplantation. IgG-lambda and IgG-kappa bands predominated. In
48% of the cases the oligoclonal Igs disappeared after a median follow-up
of 22 months (range 8-36), whereas in 52% of the cases the oligoclonal Igs
persisted with a median follow-up of 31 months (range 21-45), which did not
correlate with a significant difference in overall, and event-free surviva
l between both subgroups.