Busulfan, cyclophosphamide, and etoposide as conditioning for autologous stem cell transplantation in multiple myeloma

✍ Scribed by Christopher R. Cogle; Jan S. Moreb; Helen L. Leather; Katarzyna J. Finiewicz; Shahab A. Khan; Vijay S. Reddy; John R. Wingard

• Publisher: John Wiley and Sons
• Year: 2003
• Tongue: English
• Weight: 77 KB
• Volume: 73
• Category: Article
• ISSN: 0361-8609
• DOI: 10.1002/ajh.10342

✦ Synopsis

Abstract

Autologous stem cell transplantation (ASCT) has enabled the use of high‐dose alkylating agents either as a single agent or in combination with other cytotoxic agents and/or total body irradiation (TBI) for the treatment of multiple myeloma. Despite improved complete remission rates, relapse and regimen‐related toxicities remain challenging. In an effort to increase event‐free survival and decrease the high incidence of regimen‐related toxicity, we have studied the use of etoposide in combination with reduced‐dose busulfan and cyclophosphamide as a conditioning regimen for ASCT in a group of 26 patients with advanced multiple myeloma. Median follow‐up for the group was 30 months. There was no early treatment‐related mortality. The main toxicity was mucositis. Otherwise, there was 1 case of reversible, clinically diagnosed hepatic veno‐occlusive disease. Post‐engraftment, 10 patients (38%) achieved CR, 15 (58%) patients achieved PR or SD, and 1 patient developed progressive disease (4%). Five patients in PR and 1 with progressive disease before transplant attained a CR post‐transplant. The median times for event‐free survival and overall survival after transplantation were 24 and 43 months, respectively. In conclusion, conditioning with busulfan, cyclophosphamide, and etoposide followed by ASCT is a safe regimen with comparable effectiveness to other previously used preparative regimens, thus providing another approach of non‐TBI containing high‐dose chemotherapy for patients with multiple myeloma. Am. J. Hematol. 73:169–175, 2003. © 2003 Wiley‐Liss, Inc.