Tandem autologous hematopoietic cell transplantation with sequential use of total marrow irradiation and high-dose melphalan in multiple myeloma

• Published in: Bone marrow transplantation (Basingstoke) Vol. 56; no. 6; pp. 1297 - 1304
• Main Authors: Giebel, Sebastian, Sobczyk-Kruszelnicka, Małgorzata, Blamek, Sławomir, Saduś-Wojciechowska, Maria, Najda, Jacek, Czerw, Tomasz, Mendrek, Włodzimierz, Woźniak, Grzegorz, Jochymek, Bożena, Radwan, Michał, Leszczyński, Wojciech, Dolla, Łukasz, D’Amico, Andrea, Ślosarek, Krzysztof, Hołowiecki, Jerzy, Miszczyk, Leszek
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.06.2021; Nature Publishing Group
• Subjects: 692/700/565/2319; 692/700/565/485; Adult; Autografts; Bone Marrow; Care and treatment; Cell Biology; Dosage and administration; Hematology; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Humans; Internal Medicine; Irradiation; Medicine; Medicine & Public Health; Melphalan; Middle Aged; Multiple myeloma; Multiple Myeloma - therapy; Neutropenia; Nucleotide sequence; Public Health; Radiation; Radiation dosage; Radiotherapy; Remission; Stem cell transplantation; Stem Cells; Testing; Toxicity; Transplantation; Transplantation Conditioning; Transplantation, Autologous; Treatment Outcome; Poland
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/s41409-020-01181-x

The goal of this phase II trial was to evaluate safety and efficacy of a tandem autologous hematopoietic cell transplantation (auto-HCT) using sequentially total marrow irradiation (TMI) at the dose of 12 Gy (4 Gy on days −3, −2, and −1) and melphalan 200 mg/m 2 for patients with multiple myeloma (MM). TMI was performed using helical tomotherapy. Additional “boosts” (total 24 Gy) were applied for patients with active lesions as revealed by PET-FDG. Fifty patients with median age 58 years (41–64 years) were included and received tandem auto-HCT. TMI resulted in absolute neutropenia in all patients. Grade 3 infections were reported in 30% patients. Other toxicities were rare. Proportion of patients who achieved at least very good partial response increased from 46% before the first auto-HCT to 82% after tandem transplantation. Complete remission rates changed from 10% to 42%, respectively. The probabilities of overall and progression-free survival at 5 years were 74% and 55%, respectively. No patient died without progression. We conclude that conditioning with TMI ± PET-guided “boosts” represents personalized treatment approach in MM and is characterized by very good toxicity profile. Tandem auto-HCT using TMI in sequence with high-dose melphalan appears safe with encouraging early efficacy.