The effects of prior induction therapy with melphalan on subsequent peripheral blood progenitor cell transplantation for myeloma

High dose chemoradiotherapy with autologous peripheral blood progenitor cel l transplantation (PBPCT) may improve outcome in myeloma. Melphalan is an e ffective drug in the treatment of myeloma, but is potentially toxic to prog enitor cells. We studied 8 patients receiving intermittent intravenous melp halan (25 mg/m(2)) as induction therapy before PBPCT to assess engraftment characteristics post-transplantation. Comparison was made with an age-match ed control group of patients with non-Hodgkins lymphoma who had not receive d melphalan during induction therapy. There was correlation (P=0.037) betwe en the dose of melphalan per kg body weight given, premobilization, and day s to neutrophil engraftment, but no significant difference between the two groups in neutrophil recovery. The study group had delayed platelet recover y (P=0.01) and required more platelet support post-transplantation (P=0.05) . 3-4 weekly melphalan (25 mg/m(2)) up to 6 courses was delivered to patien ts who went on to PBPCT without significantly influencing neutrophil recove ry but with a negative impact on platelet recovery.