Impact of early response to sequential high-dose chemotherapy on outcome of patients with advanced myeloma and poor prognostic features Journal Article
| Authors: | Niesvizky, R.; Siegel, D.; Glassman, J.; Straus, D.; Fine, J.; Lyons, L.; Michaeli, J. |
| Article Title: | Impact of early response to sequential high-dose chemotherapy on outcome of patients with advanced myeloma and poor prognostic features |
| Abstract: | We report the results of a dose-intense chemotherapy regimen designed to rapidly induce remissions in patients with advanced multiple myeloma (MM). Patients received VAD for 3-6 cycles depending on response kinetics. This was followed by three sequential cycles of cyclophosphamide (CTX) at 3 g/m2 every 15 days with G-CSF support. 71% of these patients had stage IIIa, 23% had renal failure. The median age was 58, median β-2 microglobulin 4.6 and median albumin was 3.5, indicating poor prognosis. Of 35 patients, 66% achieved a complete response (CR) (SWOG). Six patients (18%) had a partial response. Fifty percent of the patients with renal failure recovered their kidney function. High-dose CTX contributed to tumor-mass reduction particularly in patients presenting with high-tumor burden. Tumor-mass reduction following three pulses of dexamethasone (4 days each) is significantly higher than with one pulse (p < 0.005). While high β-2 microglobulin and LDH levels (p < 0.05) were associated with poor outcome, patients who responded faster to chemotherapy had a longer survival (p = 0.005). We conclude that this regimen is safe and effective. A rapid response may be useful in selecting patients who may benefit from further high dose chemotherapy and stem cell support. |
| Keywords: | adult; cancer survival; clinical article; controlled study; treatment outcome; aged; middle aged; clinical feature; clinical trial; salvage therapy; doxorubicin; advanced cancer; diarrhea; drug efficacy; drug safety; patient selection; cancer patient; cancer staging; drug megadose; follow-up studies; biological markers; controlled clinical trial; multiple myeloma; tumor volume; antineoplastic combined chemotherapy protocols; cyclophosphamide; dexamethasone; vincristine; kidney failure; stem cell transplantation; time factors; fever; cancer regression; albumin; kidney function; remission induction; nausea and vomiting; lactate dehydrogenase; bacteremia; beta 2 microglobulin; alopecia; granulocyte colony stimulating factor; l-lactate dehydrogenase; myeloma; high-dose cyclophosphamide; humans; prognosis; human; male; female; priority journal; article; beta 2-microglobulin; rapid response; vad |
| Journal Title: | Leukemia and Lymphoma |
| Volume: | 43 |
| Issue: | 3 |
| ISSN: | 1042-8194 |
| Publisher: | Taylor & Francis Group |
| Date Published: | 2002-01-01 |
| Start Page: | 607 |
| End Page: | 612 |
| Language: | English |
| DOI: | 10.1080/10428190210324 |
| PUBMED: | 12002766 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Export Date: 14 November 2014 -- Source: Scopus |
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