/     /     /  

Intermediate Dose Melphalan for de novo Multiple Myeloma gives high complete response rate and durable long term survival

Reviewer: Julie Draznin Maltzman, MD
OncoLink
Ultima Vez Modificado: 7 de diciembre del 2002

Presenter: Mathew Streetly
Presenter's Affiliation: Queen Elizabeth Hospital, Woolwich, UK
Type of Session: Poster

Background

• Multiple Myeloma remains a disease with extremely high recurrence rates even after agressive chemotherapy.
• Oral Melphalan has a median survival rate of 2-4 years in those pts who respond. Complete remission is achieved in <5% of the patients.
• IV Melphalan can produce more predictable plasma levels than the oral formulation and can produce a higher rate of complete remission.
• This abstract presents data of intermediate dose IV Melphalan as initial induction therapy with high response rates.

Materials and Methods

• This was a multicenter, non-randomized, prospective study of consecutive previously untreated stage II or III Multiple Meyloma pts.
• Pts recieved 25mg/m2 over 30 minutes of Melphalan with dexamethasone 40mg orally each day for four days. Treatment was repeated every 28 days.
• Pts also received maintenance therapy if interferon of 1-3 MU 3X weekly.
• Response rate was measured by serum and urine paraprotien levels and amount of bone marrow plasma cells.

Results

• Overall response rate was 66% (a reduction in >25% of paraprotien level) of which 33% were were complete responders.
• 6 patients had stable disease on this therapy.
• 15 patients proceeded to autologous bone marrow transplants
• 21% of these patients continue to be alive at 109 months of follow up.
• Treatment was well tolorated. Only 4 deaths occurred during the study. One was treatement related -- due to sepsis. 2 deaths were non treatment related -- vascular events. And one death was unexplained.

Author's Conclusions

• Intermediate dose Melphalan is well tolerated and capable of producing complete remission responses equal to those published with high dose melphalan.
• Most pts had enough of a stem cell reserve to allow for a subsequent autologous bone marrow transplant.

Clinical/Scientific Implications

Intermediate dose IV Melphalan, as opposed to high dose, is an effective treatment for Multiple Myeloma with long term survival.

Oncolink's ASH Coverage made possible by an unrestricted Educational Grant from Ortho Biotech.