Treatment of multiple myeloma patients with autologous stem cell transplantation — a fresh analysis

Patients with multiple myeloma (MM) treated with conventional chemotherapy have an average survival of approximately three years. High dose chemotherapy followed by autologous stem cell transplantation (ASCT), first introduced in the mid-1980s, is now considered the standard therapy for almost all patients with multiple myeloma, because it prolongs overall survival and disease free survival. Between November 1997 and October 2006, 122 patients with MM (58 females, 64 males, median age 51.0 years [± 7.98] range: 30–66 years) were transplanted in the Department of Hematooncology and Bone Marrow Transplantation at the Medical University of Lublin: 47 patients were in complete remission or in unconfirmed complete remission, 66 patients were in partial remission, and nine had stable disease. Of these, there were 95 patients with IgG myeloma, 16 with IgA myeloma, one with IgG/IgA, one with IgM myeloma, five with non secretory type, two with solitary tumor and two with LCD myeloma. According to Durie-Salmon, 62 patients had stage III of the disease, 46 had stage II and four had stage I. Most patients (69/122) were transplanted after two or more cycles of chemotherapy, 48 patients were transplanted after one cycle of chemotherapy, one patient after surgery and rtg- -therapy and four patients had not been treated. In mobilisation procedure, the patients received a single infusion of cyclophosphamide (4–6 g/m2) or etoposide 1.6 g/m2 followed by daily administration of G-CSF until the peripheral stem cells harvest. The number of median harvest sessions was 2.0 (± 0.89) (range: 1–5). An average of 7.09 (± 33.28) × 106 CD34+ cells/kg were collected from each patient (range: 1.8–111.0 × 106/kg). Conditioning regimen consisted of high dose melphalan 60–210 mg/m2 without TBI. An average of 3.04 (± 11.59) × 106 CD34+ cells/kg were transplanted to each patient. Fatal complications occured in four patients (treatment- -related mortality = 3.2%). In all patients there was regeneration of hematopoiesis. The median number of days for recovery to ANC > 0.5 × 109/l was 13 (± 4.69) (range: 10–38) and platelets recovery to > 50 × 109/l was 25 days (± 11.65) (range: 12–45). Median time of hospitalization was 22 days (± 7.14) (range: 14–50). Patients were evaluated on day 100 after transplantation: 74.9% achieved CR and nCR, 14.3% were in PR, 5.4% had SD and 5.4% had progressed. Median of OS was 45 months (± 30.67). OS at 3-years was 84% and at 7-years 59%. Median PFS was 25 months (± 26.13). PFS at 3-years was 68%, and at 7-years was 43%. At present (November 2009) 52 patients (42%) are still alive. High-dose chemotherapy followed by autologous stem cell transplantation is a valuable, well tolerated method of treatment for patients with MM that allows the achievement of long- -lasting survival. (Folia Histochemica et Cytobiologica 2011; Vol. 49, No. 2, pp. 248–254

Thalidomide, dexamethasone and lovastatin with autologous stem cell transplantation as a salvage immunomodulatory therapy in patients with relapsed and refractory multiple myeloma

The treatment of patients with multiple myeloma usually includes many drugs including thalidomide, lenalidomide and bortezomib. Lovastatin and other inhibitors of HMG-CoA reductase demonstrated to exhibit antineoplasmatic and proapoptotic properties in numerous in vitro studies involving myeloma cell lines. We treated 91 patients with relapsed or refractory multiple myeloma with thalidomide, dexamethasone and lovastatin (TDL group, 49 patients) or thalidomide and dexamethasone (TD group, 42 patients). A clinical response defined of at least 50% reduction of monoclonal band has been observed in 32% of TD patients and 44% of TDL patients. Prolongation of overall survival and progression-free survival in the TDL group as compared with the TD group has been documented. The TDL regimen was safe and well tolerated. The incidence of side effects was comparable in both groups. Plasma cells have been cultured in vitro with thalidomide and lovastatin to assess the impact of both drugs on the apoptosis rate of plasma cells. In vitro experiments revealed that the combination of thalidomide and lovastatin induced higher apoptosis rate than apoptosis induced by each drug alone. Our results suggest that the addition of lovastatin to the TD regimen may improve the response rate in patients with relapsed or refractory myeloma

High efficacy and safety of VTD as an induction protocol in patients with newly diagnosed multiple myeloma eligible for high dose therapy and autologous stem cell transplantation : a report of the Polish Myeloma Study Group

The present retrospective analysis evaluated the efficacy and safety of the VTD (bortezomib, thalidomide, dexamethasone) regimen in 205 newly‑diagnosed patients with multiple myeloma (MM) eligible for high dose therapy and autologous stem cell transplantation (HDT/ASCT) in routine clinical practice. With a median of 6 cycles (range, 1‑8), at least partial response was achieved in 94.6% and at least very good partial response (VGPR) was achieved in 67.8% of patients. Peripheral neuropathy (PN) grade 2‑4 was observed in 28.7% of patients. In 72% of patients undergoing stem cell mobilization one apheresis allowed the number of stem cells sufficient for transplantation to be obtained. Following HDT/ASCT the sCR rate increased from 4.9 to 14.4% and CR from 27.8 to 35.6%. The results demonstrated that VTD as an induction regimen was highly efficient in transplant eligible patients with MM with increased at least VGPR rate following prolonged treatment (≥6 cycles). Therapy exhibited no negative impact on stem cell collection, neutrophils and platelets engraftment following ASCT. Therapy was generally well tolerated and PN was the most common reason of dose reduction or treatment discontinuation

Wpływ stresu oksydacyjnego na przebieg kliniczny ostrych białaczek mieloblastycznych

The aim of the study was to evaluate the influence of oxidative potential and activity of antioxidants on the course and chemotherapy response in acute nonlymphoblastic leukaemias.Material and methodsTwelve adult patients (7 women, 5 men) with acute nonlymphoblastic leukaemia treated at the Department of Hematooncology University Medical School in Lublin, were studied. Plasma concentration of malondialdehyde (MDA) was determined using fluorimetric assay. Activities of superoxide dismutase (SOD) and glutathione peroxidase (PGx) were assesed in the whole blood using colorimetric assay with Randox reagents.ResultsThe overall survival in the group of patients with a low activity of GPx (< 5.0 U/ml) was significantly longer than that in patients with a high activity of GPx (15.71±9.8 vs 5.8±3.68 month). Patients with hepatosplenomegaly were characterized by a significantly lower activity of SOD (52.0U/ml) compared to patients without hepatosplenomegaly (95.12 U/ml).ConclusionThe state of the new balance between different defence mechanisms of an oxidation-reduction system, resulting from the presence of acute proliferation, may modulate the course of acute leukaemias and influence the response to chemotherapy.CelemPracy było stwierdzenie wpływu potencjału oksydacyjnego, a także aktywności przeciwutleniaczy na przebieg kliniczny ostrych białaczek mieloblastycznych i odpowiedź na chemioterapię.Materiał i metodaGrupę badaną stanowiło 12 chorych (7 kobiet i 5 mężczyzn) na ostrą białaczkę mieloblastyczną leczonych w Klinice Hematoonkologii AM w Lublinie. Stężenie MDA w osoczu krwi oznaczono metodą fluorymetryczną, natomiast aktywność dysmutazy ponadtlenkowej(SOD) i peroksydazyglutationu (GPx) we krwi pełnej oznaczono metodą kolorymetryczną przy użyciu odczynników Randox.WynikiCzas przeżycia w grupie chorych z małą aktywnością GPx

Treatment of multiple myeloma patients with autologous stem cell transplantation — a fresh analysis

Patients with multiple myeloma (MM) treated with conventional chemotherapy have an averagesurvival of approximately three years. High dose chemotherapy followed by autologous stem cell transplantation(ASCT), first introduced in the mid-1980s, is now considered the standard therapy for almost all patientswith multiple myeloma, because it prolongs overall survival and disease free survival. Between November 1997and October 2006, 122 patients with MM (58 females, 64 males, median age 51.0 years [± 7.98] range: 30–66years) were transplanted in the Department of Hematooncology and Bone Marrow Transplantation at the MedicalUniversity of Lublin: 47 patients were in complete remission or in unconfirmed complete remission,66 patients were in partial remission, and nine had stable disease. Of these, there were 95 patients with IgG myeloma,16 with IgA myeloma, one with IgG/IgA, one with IgM myeloma, five with non secretory type, two withsolitary tumor and two with LCD myeloma. According to Durie-Salmon, 62 patients had stage III of the disease,46 had stage II and four had stage I. Most patients (69/122) were transplanted after two or more cycles ofchemotherapy, 48 patients were transplanted after one cycle of chemotherapy, one patient after surgery and rtg--therapy and four patients had not been treated. In mobilisation procedure, the patients received a single infusionof cyclophosphamide (4–6 g/m2) or etoposide 1.6 g/m2 followed by daily administration of G-CSF until theperipheral stem cells harvest. The number of median harvest sessions was 2.0 (± 0.89) (range: 1–5). An averageof 7.09 (± 33.28) × 106 CD34+ cells/kg were collected from each patient (range: 1.8–111.0 × 106/kg). Conditioningregimen consisted of high dose melphalan 60–210 mg/m2 without TBI. An average of 3.04 (± 11.59) × 106CD34+ cells/kg were transplanted to each patient. Fatal complications occured in four patients (treatment--related mortality = 3.2%). In all patients there was regeneration of hematopoiesis. The median number of daysfor recovery to ANC > 0.5 × 109/l was 13 (± 4.69) (range: 10–38) and platelets recovery to > 50 × 109/l was 25days (± 11.65) (range: 12–45). Median time of hospitalization was 22 days (± 7.14) (range: 14–50). Patientswere evaluated on day 100 after transplantation: 74.9% achieved CR and nCR, 14.3% were in PR, 5.4% had SDand 5.4% had progressed. Median of OS was 45 months (± 30.67). OS at 3-years was 84% and at 7-years 59%.Median PFS was 25 months (± 26.13). PFS at 3-years was 68%, and at 7-years was 43%. At present (November2009) 52 patients (42%) are still alive. High-dose chemotherapy followed by autologous stem cell transplantationis a valuable, well tolerated method of treatment for patients with MM that allows the achievement of long--lasting survival

Treatment of multiple myeloma patients with autologous stem cell transplantation &amp;#8212; a fresh analysis

Patients with multiple myeloma (MM) treated with conventional chemotherapy have an average survival of approximately three years. High dose chemotherapy followed by autologous stem cell transplantation (ASCT), first introduced in the mid-1980s, is now considered the standard therapy for almost all patients with multiple myeloma, because it prolongs overall survival and disease free survival. Between November 1997 and October 2006, 122 patients with MM (58 females, 64 males, median age 51.0 years [&amp;#177; 7.98] range: 30&amp;#8211;66 years) were transplanted in the Department of Hematooncology and Bone Marrow Transplantation at the Medical University of Lublin: 47 patients were in complete remission or in unconfirmed complete remission, 66 patients were in partial remission, and nine had stable disease. Of these, there were 95 patients with IgG myeloma, 16 with IgA myeloma, one with IgG/IgA, one with IgM myeloma, five with non secretory type, two with solitary tumor and two with LCD myeloma. According to Durie-Salmon, 62 patients had stage III of the disease, 46 had stage II and four had stage I. Most patients (69/122) were transplanted after two or more cycles of chemotherapy, 48 patients were transplanted after one cycle of chemotherapy, one patient after surgery and rtg- -therapy and four patients had not been treated. In mobilisation procedure, the patients received a single infusion of cyclophosphamide (4&amp;#8211;6 g/m&lt;sup&gt;2&lt;/sup&gt;) or etoposide 1.6 g/m&lt;sup&gt;2&lt;/sup&gt; followed by daily administration of G-CSF until the peripheral stem cells harvest. The number of median harvest sessions was 2.0 (&amp;#177; 0.89) (range: 1&amp;#8211;5). An average of 7.09 (&amp;#177; 33.28) × 106 CD34&lt;sup&gt;+&lt;/sup&gt; cells/kg were collected from each patient (range: 1.8&amp;#8211;111.0 × 106/kg). Conditioning regimen consisted of high dose melphalan 60&amp;#8211;210 mg/m&lt;sup&gt;2&lt;/sup&gt; without TBI. An average of 3.04 (&amp;#177; 11.59) × 106 CD34+ cells/kg were transplanted to each patient. Fatal complications occured in four patients (treatment- -related mortality = 3.2%). In all patients there was regeneration of hematopoiesis. The median number of days for recovery to ANC &gt; 0.5 × 10&lt;sup&gt;9&lt;/sup&gt;/l was 13 (&amp;#177; 4.69) (range: 10&amp;#8211;38) and platelets recovery to &gt; 50 × 10&lt;sup&gt;9&lt;/sup&gt;/l was 25 days (&amp;#177; 11.65) (range: 12&amp;#8211;45). Median time of hospitalization was 22 days (&amp;#177; 7.14) (range: 14&amp;#8211;50). Patients were evaluated on day 100 after transplantation: 74.9% achieved CR and nCR, 14.3% were in PR, 5.4% had SD and 5.4% had progressed. Median of OS was 45 months (&amp;#177; 30.67). OS at 3-years was 84% and at 7-years 59%. Median PFS was 25 months (&amp;#177; 26.13). PFS at 3-years was 68%, and at 7-years was 43%. At present (November 2009) 52 patients (42%) are still alive. High-dose chemotherapy followed by autologous stem cell transplantation is a valuable, well tolerated method of treatment for patients with MM that allows the achievement of long- -lasting survival. (Folia Histochemica et Cytobiologica 2011; Vol. 49, No. 2, pp. 248&amp;#8211;254