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Myeloma

High-dose melphalan with G-CSF-stimulated whole blood rescue followed by stem cell harvesting and busulphan/cyclophosphamide with autologous stem cell transplantation in multiple myeloma

Bone Marrow Transplantation volume 27, pages 925–931 (2001)Cite this article

Abstract

In 90 consecutive patients with multiple myeloma, we investigated the feasibility of administering a tandem high-dose therapy regimen, using whole blood for rescue after the first and leucapheresis harvested between the two high doses, for rescue after the second high dose. After 5 days of G-CSF 1 litre of whole blood (WB) was obtained, left undisturbed at 4°C and reinfused 24 h after HDM (140 mg/m2). Patients not in progression after 3–6 months were again mobilised, leucapheresed and treated with busulphan 16 mg/kg and cyclophosphamide 120 mg/kg (Bu/Cy) and reinfusion. In 90 patients, WB contained a mean (range) of 0.57 (0.02–3.22) × 106/kg CD34+ cells. Recovery after HDM was in 13 days for granulocytes and in 18 days for platelets, with 11 patients not recovering within 3 months. There were three toxic deaths. Sixty-six patients qualified for harvesting after HDM. In the first 11, marrow was harvested. The subsequent 55 patients were mobilised and in 45 the preset minimum of 1.5 × 106 CD34+ cells was obtained. Forty-nine patients actually received Bu/Cy. Recovery after Bu/Cy and marrow reinfusion was in 35 days for granulocytes and 20 days for platelets, with two of five patients not recovering after 3 months. After Bu/Cy and leucapheresis reinfusion, recovery was in 17 days for granulocytes and in 34 days for platelets. Nine patients did not recover within 3 months. There were four toxic deaths. The median overall survival from diagnosis for patients receiving HDM was 49 months and for patients also receiving Bu/Cy, 84 months. We conclude that WB rescue after HDM followed by leucapheresis and a second transplant is feasible in the majority of patients. Better mobilisation techniques are required to increase the number of patients who can receive the second transplant. Bone Marrow Transplantation (2001) 27, 925–931.

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Acknowledgements

We thank IJM Gloudemans and AM de Kreuk for their contribution to this study. We also thank the nursing staff for their care for these patients.

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  1. Department of Haematology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands

    PC Huijgens, HM Dekker-van Roessel, AR Jonkhoff, GC Admiraal, S Zweegman, GJ Schuurhuis & GJ Ossenkoppele

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  1. PC Huijgens
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Huijgens, P., Dekker-van Roessel, H., Jonkhoff, A. et al. High-dose melphalan with G-CSF-stimulated whole blood rescue followed by stem cell harvesting and busulphan/cyclophosphamide with autologous stem cell transplantation in multiple myeloma. Bone Marrow Transplant 27, 925–931 (2001). https://doi.org/10.1038/sj.bmt.1703013

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