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Syngeneic marrow transplantation in multiple myeloma
D Topolsky1, P Crilley, N Leasure
1Hahnemann University Hospital, Philadelphia, PA 19102-1192.
Leukemia Research
|January 1, 1992
Summary
Two IgA multiple myeloma cases showed positive response to a non-total body irradiation (TBI) conditioning regimen using busulfan and cyclophosphamide (Bu/Cy) before syngeneic bone marrow transplant. This effective regimen warrants consideration for earlier aggressive myeloma treatment.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Multiple myeloma is a hematologic malignancy characterized by uncontrolled proliferation of plasma cells.
- IgA myeloma is a subtype that can present aggressively.
- Syngeneic bone marrow transplantation is a potential curative therapy, but conditioning regimens are critical.
Observation:
- Two patients with stage III IgA multiple myeloma received a conditioning regimen of busulfan and cyclophosphamide (Bu/Cy) prior to syngeneic bone marrow transplant.
- Both patients initially achieved complete remission with no evidence of residual myeloma at 40 days post-transplant.
- One patient succumbed to disseminated Aspergillus fumigatus infection, while the other experienced relapse at 18 months.
Findings:
- The busulfan and cyclophosphamide (Bu/Cy) conditioning regimen demonstrated efficacy in achieving remission for aggressive IgA multiple myeloma.
- The non-total body irradiation (TBI) approach was effective in myeloablation for syngeneic transplant.
- Despite initial success, long-term outcomes were affected by infection and relapse.
Implications:
- The Bu/Cy conditioning regimen is a viable option for aggressive myeloma, potentially avoiding total body irradiation (TBI).
- Consideration for earlier intervention with this myelo-ablative conditioning regimen in aggressive myeloma cases may improve outcomes.
- Further research is needed to optimize supportive care and mitigate risks like opportunistic infections and relapse.