- Volume 6
- Issue 6 Publication Date: May 2006
Intermediate-Dose Melphalan (100 mg/m2)/Bortezomib/Thalidomide/Dexamethasone and Stem Cell Support in Patients with Refractory or Relapsed Myeloma
Antonio Palumbo, Ilaria Avonto, Benedetto Bruno, Antonietta Falcone, Potito Rosario Scalzulli, Maria Teresa Ambrosini, Sara Bringhen, Francesca Gay, Cecilia Rus, Federica Cavallo, Patrizia Falco, Massimo Massaia, Pellegrino Musto, Mario Boccadoro
Background: Bortezomib and thalidomide have shown synergy with melphalan and dexamethasone. We used this 4-drug combination as conditioning before autologous hematopoietic cell infusions. Patients and Methods: Twenty-six patients with advanced-stage myeloma were treated with melphalan 50 mg/m2 and bortezomib 1.3 mg/m2 on days -6 and -3 in association with thalidomide 200 mg and dexamethasone 20 mg on days -6 through -3, followed by hematopoietic cell support on day 0. Results: Nonhematologic toxicities included pneumonia, febrile neutropenia, and peripheral neuropathy. All patients had undergone autologous transplantation at diagnosis, and 13 patients (50%) underwent an additional transplantation at relapse. Responses occurred in 17 of 26 patients (65%), including 1 complete remission, 3 near complete remissions (12%), and 2 very good partial remissions (8%). Response rate was higher than that induced by the previous line of treatment in 12 patients (46%). Conclusion: Melphalan/bortezomib/thalidomide/dexamethasone showed encouraging antimyeloma activity in patients with advanced-stage myeloma.