Dexamethasone, paclitaxel, etoposide, cyclophosphamide (d-TEC) and G-CSF for stem cell mobilisation in multiple myeloma

Forty-one patients with multiple myeloma were treated with a novel stem cel l mobilisation regimen. The primary end points were adequate stem cell mobi lising ability (>1% circulating CD34-positive cells) and collection (greate r than or equal to4 x 10(6) CD34-positive cells/kg), and safety. The second ary end point was activity against myeloma. The regimen (d-TEC) consisted o f dexamethasone, paclitaxel 200 mg/m(2) i.v., etoposide 60 mg/kg i.v., cycl ophosphamide 3 g/m(2) i.v., and G-CSF 5-10 mug/kg/day i.v. A total of 84 cy cles were administered to these 41 individuals. Patient characteristics inc luded a median age of 53 years, a median of five prior chemotherapy cycles, and a median interval of 10 months from diagnosis of myeloma to first cycl e of d-TEC. Seventy-five percent of the patients had stage II or III diseas e, 50% had received carmustine and/or melphalan previously, and 25% had rec eived prior radiation therapy. Eighty-eight percent of patients mobilised a dequately after the first cycle of d-TEC and 91% mobilized adequately after the second cycle. An adequate number of stem cells were collected in 32 pa tients. Of the remaining nine patients, three mobilised, but stem cells wer e not collected, two mobilised but stem cell collection was <4 x 10(6) CD34 -positive cells/kg, three did not mobilise, and one died of disease progres sion. Major toxicities included pancytopenia, alopecia, fever and stomatiti s. One patient died from multi-organ failure and progressive disease. Fifty percent of evaluable patients demonstrated a partial response and 28.6% of patients had a minor response. This novel dose-intense regimen was safe, c apable of stem cell mobilisation and collection, even in heavily pre-treate d patients, and active against the underlying myeloma.