High-dose chemotherapy with autologous stem-cell support in multiple myeloma

Between 1992 and 1999 15 patients (pts.) suffering from multiple myeloma (M RI) were treated with high-dose chemotherapy and consecutive autologous ste m-cell transplantation (ASTx). 10/15 pts underwent two courses of ASTx (tan dem- or double ASTx). So 25 ASTx were performed in these 15 pts. in total. All pts. were under 60 a. of age. 13/15 pts. received 6 cycles of chemother apy on an average according to the VAD-protocol (Vincristin, Adriamycin, De xamethason). Mobilisation of peripheral hematopoietic stem cells was perfor med with high-dose cyclophosphamide and hematopoietic growth-factors (CSFs) . The conditioning protocol consisted of high-dose melphalan (200-225 mg/m( 2)) in 24/25 ASTx. In one single case total body irradiation (TBI) plus mel phalan 140 mg/m(2) was used. 2/15 pts. died within 30 days from ASTx; one p atient from interstitial pneumonia after TBI, and the other, who was in a v ery advanced stage of his disease with multiple pretreatment courses before ASTx. The overall survival (OS) was in the mean 68 months, the progression -free survival (PFS) after ASTx 21 m respectively. In pts. with MM high-dose melphalan (up to 225 mg/m(2)) without TBI plus AS Tx is a safe and effective procedure when performed in the early course of the disease.