Bridging advanced myeloma patients to subsequent treatments and clinical trials with classical chemotherapy and stem cell support

Tarek H. Mouhieddine, Erin Moshier, Santiago Thibaud, Benjamin Puliafito, Mohammad Rattu, Rita Jakubowski, Larysa Sanchez, Adriana Rossi, Cesar Rodriguez, Shambavi Richard, Hearn Jay Cho, Samir Parekh, Ajai Chari, Amir Steinberg, Joshua Richter

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Rapidly progressing relapsed/refractory multiple myeloma (RRMM) patients with compromised marrow have limited treatment options. Thus, non-myeloablative chemotherapy with a stem cell boost (SCB) may provide disease control and hematopoietic improvement as bridge to subsequent therapies. We identified 96 patients who received a SCB between January 2011 and December 2019 at the Mount Sinai Hospital. Patients had a median age of 64 years, received a median of 7 prior lines of therapy and 68 and 42% were triple-class and penta-drug refractory, respectively. Chemotherapy included melphalan (MEL) (n = 16), melphalan + carmustine (BCNU/MEL) (n = 52) or a variant of DCEP (dexamethasone, cyclophosphamide, etoposide, cisplatin) (n = 28). Median time to neutrophil recovery was 10 days and was significantly lower with DCEP (8 days) compared to MEL and BCNU/MEL (10–11 days) (p = 0.0047). Time to progression, progression-free survival and overall survival were 3.19, 2.7 and 8.38 months, respectively. The BCNU/MEL group had the highest response rate of 85% (p = 0.05), clinical benefit rate of 94% (p = 0.0014), progression-free survival of 3.3 months (p = 0.4) and overall survival of 8.7 months (p = 0.5). Sixty-six patients (69%) were bridged to new lines of therapy, including clinical trials. Non-myeloablative chemotherapy with SCB provides rapid disease control and marrow recovery with potential to receive further therapy.

Original languageEnglish
Pages (from-to)80-86
Number of pages7
JournalBone Marrow Transplantation
Volume58
Issue number1
DOIs
StatePublished - Jan 2023

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