Phase 1 Study of the Combination of Escalated Total Marrow Irradiation Using Helical Tomotherapy and Fixed High-Dose Melphalan (140 mg/m²) Followed by Autologous Stem Cell Transplantation at First Relapse in Multiple Myeloma

Cailleteau, Axel; Maingon, P.; Choquet, Sylvain; Bourdais, R.; Antoni, D.; Lioure, Bruno; Hulin, Cyrille; Batard, S.; Llagostera, C.; Guimas, V.; Touzeau, Cyrille; Moreau, Philippe; Mahé, M.‐A.; Supiot, S.

doi:10.1016/j.ijrobp.2022.09.069

Cited by 5 publications

(3 citation statements)

References 34 publications

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“…In the past, TBI has been used in combination with melphalan but has been shown to be inferior regarding toxicity and hematological recovery, with a trend towards inferior survival in comparison to a high-dose melphalan-only conditioning strategy [42]. Modern approaches with selective targeting of bone marrow (total marrow irradiation) are now being tested in this situation [43,44].…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy in Combination with Systemic Therapy for Multiple Myeloma—A Critical Toxicity Evaluation in the Modern Treatment Era

Oertel,

Schlusemann,

Shumilov

et al. 2023

Cancers

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Radiotherapy (RT) is an established treatment modality in the management of patients with multiple myeloma (MM), aiming at analgesia and stabilization of osteolytic lesions. As a multifocal disease, the combined use of RT, systemic chemotherapy, and targeted therapy (ST) is pivotal to achieve better disease control. However, adding RT to ST may lead to increased toxicity. The aim of this study was to evaluate the tolerability of ST given concurrently with RT. Overall, 82 patients treated at our hematological center with a median follow-up of 60 months from initial diagnosis and 46.5 months from the start of RT were evaluated retrospectively. Toxicities were recorded from 30 days before RT up to 90 days after RT. 54 patients (65.9%) developed at least one non-hematological toxicity, with 50 patients (61.0%) showing low-grade (grade I or II) and 14 patients (17.1%) revealing high-grade (grade III and IV) toxicities. Hematological toxicities were documented in 50 patients (61.0%) before RT, 60 patients (73.2%) during RT, and 67 patients (81.7%) following RT. After RT, patients who had received ST during RT showed a significant increase in high-grade hematological toxicities (p = 0.018). In summary, RT can be safely implemented into modern treatment regimens for MM, but stringent monitoring of potential toxicities even after completion of RT has to be ensured.

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Section: Discussionmentioning

confidence: 99%

Radiotherapy in Combination with Systemic Therapy for Multiple Myeloma—A Critical Toxicity Evaluation in the Modern Treatment Era

Oertel,

Schlusemann,

Shumilov

et al. 2023

Cancers

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“…Total marrow irradiation in autologous conditioning regimen for multiple myeloma was pioneered by Einsele et al (9). Eightynine patients with stage II-III multiple myeloma, de novo or pretreated, received TMI 9 Gy, 12 mg/kg oral busulfan (equivalent to 9.6 mg/kg intravenous busulfan), and cyclophosphamide 120 mg/kg in patients.…”

Section: Tmi In Autologous Hctmentioning

confidence: 99%

“…Cailleteau et al ( 10 ) reported the results of a phase I trial of melphalan 140 mg/m2 combined with TMI before autologous HCT for patients in their first relapse. Thirteen patients were included.…”

Section: Tmi In Autologous Hctmentioning

confidence: 99%

Total marrow irradiation in hematopoietic stem cell transplantation for hematologic malignancies

et al. 2023

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Total body irradiation (TBI) has been an essential component of the conditioning regimen in hematopoietic cell transplantation for many years. However, higher doses of TBI reduce disease relapse at the expense of more significant toxicities. Therefore, total marrow irradiation and total marrow and lymphoid irradiation have been developed to deliver organ-sparing targeted radiotherapy. Data from different studies show that TMI and TMLI can be safely administered in escalating doses in association with different chemotherapy conditioning regimen protocols, in situations with unmet needs, such as multiple myeloma, high-risk hematologic malignancies, relapsed or refractory leukemias, and elderly or frail patients, with low rates of transplant-related mortality. We reviewed the literature on applying TMI and TMLI techniques in autologous and allogeneic hematopoietic stem cell transplantation in different clinical situations.

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Is There Still a Role for Stem Cell Transplantation in Multiple Myeloma?

Gertz

2024

Hematology/Oncology Clinics of North America

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Phase 1 Study of the Combination of Escalated Total Marrow Irradiation Using Helical Tomotherapy and Fixed High-Dose Melphalan (140 mg/m²) Followed by Autologous Stem Cell Transplantation at First Relapse in Multiple Myeloma

Cited by 5 publications

References 34 publications

Radiotherapy in Combination with Systemic Therapy for Multiple Myeloma—A Critical Toxicity Evaluation in the Modern Treatment Era

Radiotherapy in Combination with Systemic Therapy for Multiple Myeloma—A Critical Toxicity Evaluation in the Modern Treatment Era

Total marrow irradiation in hematopoietic stem cell transplantation for hematologic malignancies

Is There Still a Role for Stem Cell Transplantation in Multiple Myeloma?

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