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

Talamo, Giampaolo; Claxton, David F.; Dougherty, David W.; Ehmann, Christopher; Sivik, Jeffrey; Rybka, Witold B.

doi:10.1038/bmt.2008.446

Cited by 17 publications

(5 citation statements)

References 28 publications

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“…BU/CY conditioning regimen before ASCT was tried in advanced MM in 1994, and the author has indicated that this regimen was tolerable and effective in such patients [26]. In the following years, the BU/CY regimen was conducted by Amir A et al and G Talamo et al in their research, and similar outcomes were found [27,28]. Other scholars have added thiotepa and etoposide to the BU/CY regimen, and these studies have also obtained favorable results [14,29].…”

Section: Discussionmentioning

confidence: 93%

Busulfan/Cyclophosphamide Compared with Melphalan as a Conditioning Regimen for Autologous Transplantation of Multiple Myeloma: A Long-Term Assessment

Zhou,

Zhai,

Yan

et al. 2023

JCM

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Background: Melphalan was poorly available in mainland China. The aim of this study is to explore the dose-adjusted busulfan/cyclophosphamide (BU/CY) as an alternative regimen in auto stem cell transplantation (ASCT) for multiple myeloma (MM). Methods: A total of 105 newly diagnosed MM patients undergoing ASCT during May 2012 and August 2017 were retrospectively analyzed. The BU/CY regimen was applied to 64 patients. Busulfan (9.6 mg/kg or 8.0 mg/kg in total) and cyclophosphamide (3.6 g/m2 or 3.0 g/m2 in total) were administered according to the creatinine clearance rate (CCR). A high-dose melphalan (HDMEL) regimen (200 mg/m2) was given to the other 41 patients. Results: At a median follow-up of 65 (1~119) months, estimated overall survival (OS) and progression-free survival (PFS) at 104 months in the BU/CY and HDMEL groups were 35.6% vs. 20.5% (p = 0.263) and 20.2% vs. 2.4% (p = 0.035), respectively. The median overall survival (OS) and PFS of the HDMEL and BU/CY groups were 55 vs. 70.5 months and 26 vs. 46.5 months, respectively. In multivariate analysis, the BU/CY regimen was found to be the only protective factor for PFS. No lethal toxicity was found in the BU/CY group, and treatment-related mortality (TRM) in 100 days was similar to the HDMEL group. Conclusions: MM patients may also benefit from the dose-adjusted BU/CY regimen.

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Section: Discussionmentioning

confidence: 93%

Busulfan/Cyclophosphamide Compared with Melphalan as a Conditioning Regimen for Autologous Transplantation of Multiple Myeloma: A Long-Term Assessment

Zhou,

Zhai,

Yan

et al. 2023

JCM

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“…In fact, single‐agent HD‐Mel has replaced previous regimens that incorporated total body irradiation (TBI) because of similar survival and reduced toxic death rate . Moreover, the use of other conditioning chemotherapy regimens did not improve clinical outcomes compared to HD single‐agent melphalan, based on the published experiences of several groups , including our own .…”

Section: Four Traditional Schedules Of Hd‐mel 200 Mg/m2 With (A B) mentioning

confidence: 92%

Effect of time to infusion of autologous stem cells (24 vs. 48 h) after high‐dose melphalan in patients with multiple myeloma

Talamo

Rakszawski

Rybka

et al. 2012

European J of Haematology

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High-dose melphalan (HD-Mel) is considered the current standard of care among the preparative regimens used in autologous peripheral blood stem cell transplantation (SCT) for multiple myeloma (MM), but optimal time and schedule of administration is not defined. We retrospectively analyzed outcomes and toxicities of HD-Mel administered on day -2 vs. day -1 before autologous stem cells infusion. A total of 138 consecutive MM patients treated at Penn State Hershey Cancer Institute between 2007 and 2010 were included in this study. No difference in time to hematopoietic recovery, common SCT-related toxicities, and clinical outcomes was seen between patients who received HD-Mel on day -2 (group A, n = 47), and those who received it on day -1 (group B, n = 91). Prompt and full hematopoietic recovery occurred even when stem cells were infused between 8 and 24 h after completion of chemotherapy. In the absence of prospective and randomized data, we conclude that a single I.V. infusion of HD-Mel on day -1 is a safe and effective practice, and the so-called 'day of rest' before the transplant appears not to be necessary.

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“…The introduction of intravenous busulfan and therapeutic drug monitoring have ensured safer administration and resulted in tolerable toxicity profiles. Numerous studies in MM have used both oral and intravenous busulfan as a conditioning regimen in combination mostly with melphalan 8,11,12 but also with cyclophosphamide 13,14 , idarubicin 15 , thiotepa 16 , etoposide 17 , bortezomib 18 , carmustine 19 , and with total body irradiation 20 . However, single-agent intravenous busulfan with therapeutic dose monitoring has not been studied as a conditioning regimen for MM.…”

Section: Introductionmentioning

confidence: 99%

A Phase 1 Study of Intravenous Busulfan as a Conditioning Regimen for Multiple Myeloma

et al. 2019

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The efficacy of melphalan (MEL) 140 mg/m2 pre-transplant conditioning versus MEL 200 mg/m2 for the elderly is still debated. We hypothesized that single-agent intravenous busulfan (BU) would show significant anti-myeloma efficacy and be better tolerated by elderly patients. A prospective 3+3 dose escalation study enrolled symptomatic multiple myeloma (MM) patients 65 years or older with SWOG performance 0–2 for treatment with intravenous BU pre-transplant at different administration levels. The primary objective was to determine the maximum tolerated dose (MTD) of BU that could be safely given over the least number of days. All patients, except one, received maintenance treatment post-transplant, mostly for 2 years. We enrolled 13 patients, mean age of 73 years (range 68–80). Pharmacokinetic analysis showed no greater than 2% accumulation in the 13 patients, confirming a lack of accumulation in the multi-dose regimen. No deaths occurred in the peri-transplant period. Grade 3/4 adverse effects were hematological, no dose-limiting toxicity was observed and MTD was not reached. Three patients developed grade 3 mucositis but none developed veno-occlusive disease. Ten (77%) patients achieved a complete remission (CR) post-transplant with a remarkably long average time to best response of 6.7 months (range: 6–14 m), and two attained a partial response. Median overall survival was 84 months (95% CI, 21–104) and the median progression-free survival was 60 months (95% CI, 9–93). Our results suggest that IV BU could be an alternative conditioning regimen to MEL 140 in elderly patients with MM, and supports future randomized trials.

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

Cited by 17 publications

References 28 publications

Busulfan/Cyclophosphamide Compared with Melphalan as a Conditioning Regimen for Autologous Transplantation of Multiple Myeloma: A Long-Term Assessment

Busulfan/Cyclophosphamide Compared with Melphalan as a Conditioning Regimen for Autologous Transplantation of Multiple Myeloma: A Long-Term Assessment

Effect of time to infusion of autologous stem cells (24 vs. 48 h) after high‐dose melphalan in patients with multiple myeloma

A Phase 1 Study of Intravenous Busulfan as a Conditioning Regimen for Multiple Myeloma

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