Summary:We studied the prognostic value of clinical and laboratory variables, measured before blood cell transplantation, in predicting complete response among patients undergoing autologous blood cell transplantation for relapsed or primary refractory myeloma. Sixty-seven patients who underwent transplantation for relapsed or primary refractory myeloma were studied. The overall response rate was 90%, and the complete response rate was 33%. Low  2 -microglobulin (р2.7 mg/l) was associated with a significantly better complete response rate compared with high levels (54 vs 19%, P = 0.002). Similarly, the complete response rate was 39% when the bone marrow plasma cell percentage was low (Ͻ40%) and 21% with greater involvement (P = 0.04). Complete response rate was 50% when  2 -microglobulin and bone marrow plasma cell percentage were low, 36% if either was high, and 12% when both were high (P = 0.01). Median survival measured from initial diagnosis of myeloma was 51 months. Overall survival after transplantation was better among responders who achieved complete response than those who did not: median survival, 24 vs 11 months, P = 0.04 (log-rank) and 0.009 (Gehan-Wilcoxon). Attainment of a complete response independently predicted better survival in a multivariate analysis.  2 -Microglobulin and bone marrow plasma cell percentage predict complete responders among patients undergoing transplantation for myeloma. Keywords: complete response;  2 -microglobulin; multiple myeloma; prognostic factors; transplantation Multiple myeloma is a clonal plasma cell proliferative disorder that accounts for 10% of all malignant hematologic neoplasms.1-3 In 1998, approximately 13 800 new cases of myeloma were diagnosed and more than 11 000 people died of the disease in the United States. with regimens such as vincristine, carmustine, melphalan, cyclophosphamide, and prednisone (VBMCP). With these regimens, median survival is about 3 years. 4 Only 3% of patients live longer than 10 years. 5High-dose chemotherapy, with or without total body irradiation, followed by blood cell transplantation is an alternative to conventional chemotherapy and appears to improve response rates and survival.6-8 A randomized trial in previously untreated patients with myeloma showed improved survival with autologous marrow transplantation compared with conventional chemotherapy, with 5-year survival rates of 52% and 12%, respectively.
Summary:Transplantation after high-dose chemotherapy prolongs survival in patients with multiple myeloma compared with standard therapy. It is unclear whether the optimal timing of transplantation is immediately after induction chemotherapy or whether stem cells may be cryopreserved for transplantation at subsequent progression or relapse. In this study, stem cells were collected within 6 months of diagnosis, followed by transplantation only at progression of myeloma. One hundred and eighteen patients with multiple myeloma had stem cells collected and cryopreserved. Eleven had transplants early in the disease after they demonstrated failure to respond to primary therapy. The remaining 107 were eligible for transplants when there was evidence of progressive disease. Of the 118 patients, 67 had transplants, nine died of progressive disease before transplantation, and 42 remain alive in plateau phase. The median survival of the group is 58.5 months; 67 are alive. Serum  2 -microglobulin, bone marrow labeling index (S phase), and hemoglobin level predicted overall survival (P Ͻ 0.006, P Ͻ 0.001, and P Ͻ 0.01, respectively). We conclude that early cryopreservation of blood stem cells followed by transplantation at progression is a feasible approach to therapy in patients with myeloma. The underlying biology of the disease has a greater impact on survival than the timing of transplantation. A prospective randomized trial is required to answer definitively the question of the optimal timing of blood cell transplantation. Keywords: multiple myeloma; blood cell transplantation; stem cell; myeloma prognosis Multiple myeloma is a malignancy in which chemotherapy dose escalation is an effective strategy capable of high kill of tumor cells, including drug-resistant cells.1 Survival of patients who receive dose-intensive chemotherapy and total body irradiation followed by marrow transplantation is significantly better than for those treated conventionally (60ϩ months and 37 months).2 Peripheral blood stem cell har-
Summary:cells result in durable engraftment after transplantation. 2Hematopoietic recovery can be accelerated by the use of blood stem cells mobilized with growth factors or chemoWe sought to determine factors that impact on the recovery of platelets after blood cell transplantation in therapy (or both). Hematopoietic recovery is more rapid after mobilized peripheral blood stem cell transplantation patients with multiple myeloma. We performed retrospective analyses in 51 patients undergoing blood cell than after autologous bone marrow transplantation, and hematopoietic recovery has been shown to be sustained, transplantation for multiple myeloma. The proportional-hazards model was applied to determine sigindicating that accessory cells found in the bone marrow are not required for durable engraftment. 3 The more rapid nificant risk factors. Of 51 transplants, 14 patients failed to achieve a platelet count of 50 × 10 9 /l. Median time to engraftment with mobilized stem cells is likely due to an increase in committed progenitors. The addition of bone a neutrophil count of 0.5 ×
We report two patients who experienced severe reversible encephalopathy following infusion of peripheral blood stem cells cryopreserved in 10% dimethylsulfoxide (DMSO). In one patient, reduction of DMSO level with plasmapheresis resulted in marked improvement in encephalopathy. Infusion of large volumes of cryopreserved stem cells may result in a significant toxic reaction. Plasmapheresis may be a treatment option for patients with significant toxicity related to DMSO.
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