BU and CY as conditioning regimen for autologous transplant in patients with multiple myeloma

• Published in: Bone marrow transplantation (Basingstoke) Vol. 44; no. 3; pp. 157 - 161
• Main Authors: Talamo, G, Claxton, D F, Dougherty, D W, Ehmann, C W, Sivik, J, Drabick, J J, Rybka, W
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.08.2009; Nature Publishing Group
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Autografts; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Busulfan; Busulfan - administration & dosage; Busulfan - adverse effects; Cancer; Care and treatment; Cell Biology; Combined Modality Therapy; Conditioning; Confidence intervals; Cyclophosphamide; Cyclophosphamide - administration & dosage; Cyclophosphamide - adverse effects; Dosage and administration; Drug therapy, Combination; Health aspects; Hematology; Hematopoietic Stem Cell Transplantation; Humans; Immunodeficiencies. Immunoglobulinopathies; Immunoglobulinopathies; Immunopathology; Internal Medicine; Medical sciences; Medicine; Medicine & Public Health; Melphalan; Methods; Middle Aged; Multiple myeloma; Multiple Myeloma - drug therapy; Multiple Myeloma - immunology; Multiple Myeloma - therapy; original-article; Patients; Peripheral blood; Public Health; Remission; Retrospective Studies; Stem cell transplantation; Stem Cells; Survival Rate; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation Conditioning - methods; Transplantation, Autologous; multiple myeloma; autologous transplantation; conditioning regimens; Antineoplastic agent; Stem cell; Hematopoietic cell; Myeloma; Blood; Autograft; Immunoglobulinopathy; Lymphoproliferative syndrome; Graft; Busulfan; Conditioning; Human; Immunopathology; Drug combination; Alkanediol; Malignant hemopathy; Alkanesulfonic acid; Alkylating agent; Oxazaphosphinane derivatives; Chemotherapy; Cyclophosphamide; Treatment; Nitrogen mustard; Therapeutic protocol; Cancer
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2008.446

High-dose melphalan is considered the current standard of care among the preparative regimens used in peripheral blood autologous SCT (ASCT) for multiple myeloma (MM). We report the results of a single ASCT in 79 MM patients using the BU/CY conditioning regimen, with BU 1 mg/kg p.o. or 0.8 mg/kg i.v. every 6 h × 16 doses, and CY 60 mg/kg per day i.v. for 2 days. ASCT was carried out in first (62%) or subsequent remission/refractory disease (38%). For an overall RR of 86%, 48 and 20 patients achieved PR and CR, respectively. At a median follow-up of 41 months (range 2–132 months), the estimated median OS and PFS were 45 months (95% confidence interval (CI)=38–92) and 20 months (95% CI=15–25), respectively. The BU/CY regimen was well tolerated, and transplant-related mortality was 4%. Clinical outcomes of the BU/CY regimen are not superior to those obtained in historical controls with high-dose melphalan followed by a single ASCT. Therefore, considering even the greater complexity of administration of the BU/CY regimen compared with that of single-agent melphalan, we believe the latter should remain the conditioning regimen of choice for ASCT in MM.