Veno-occlusive disease of the liver after high-dose cytoreductive therapy with busulfan and melphalan for autologous blood stem cell transplantation in multiple myeloma patients.

Multiple myeloma, for all practical purposes, remains an incurable malignancy; however, 5-year survival has improved substantially during the past 30 years. A major contribution to improved outcome is the use of high-dose chemotherapy and stem cell transplantation. This multifaceted approach to therapy requires an understanding of appropriate induction therapy, techniques for stem cell mobilization, appropriate conditioning and supportive care. Also of importance are prognosis, features that predict outcome, the suitability of transplant candidates, and post-transplantation maintenance therapy.

High-dose chemotherapy with autologous hematopoietic stem cell transplantation in patients with multiple myeloma.

B cell lymphoma (BCL) comprises a biologically and clinically heterogeneous group of tumors deriving from different stages of B cell development. The immunoglobulin (Ig) variable heavy chain (VH) g ...

Immunoglobulin gene analysis in different B cell lymphomas : with focus on cellular origin and antigen selection.

/pdf/comprehensive-summaries-of-uppsala-dissertations-from-the-2bli2qhvt4.pdf

Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 1375 Immunoglobulin Gene Analysis in Different B cell Lymphomas With Focus on Cellular Origin and Antigen Selection

This research is to investigate the parameters which may affect the mobilization of stem cells in patients receiving autologous hematopoietic peripheral blood stem cell transplantation (PBSCT). A retrospective study was carried out using the data derived from the medical files of 242 patients who received PBSCT. Descriptive, clinical, and laboratory parameters were compared between patients with successful and unsuccessful stem cell mobilization. Successful stem cell mobilization ratio was 4.463 times higher when preemptive plerixafor was administrated; 1.032 times higher when CD34+ cell count increased 1 unit at the beginning of mobilization. The white blood cell count was inversely correlated with the success of mobilization. An increase of 1 unit in WBC count was associated with a 1.027 times decrease in the success rate. The data indicated that the administration of preemptive plerixafor and CD34+ cell count at the beginning of mobilization were directly related to the success of mobilization after PBSCT. On contrary, WBC count was inversely associated with the success rate.

/pdf/peripheral-stem-cell-mobilization-strategies-in-patients-276tncmg33.pdf

Peripheral stem cell mobilization strategies in patients with autologous hematopoietic cell transplantation: A single center's experience

Background: Even after high dose chemotherapy (HDT) and autologous haemopoietic stem cell transplantation, the majority of patients with multiple myeloma eventually relapse.



Aim:  The aim of the present study was to study the ­feasibility and outcome of delivering a regimen including in vivo and in vitro purging and double HDT in patients with multiple myeloma.



Methods:  Thirty-four patients with advanced multiple myeloma were enrolled in a program of vincristine, doxo­rubicin and dexamethasone chemotherapy, high dose cyclophosphamide/granulocyte macrophage colony stimulating factor (GM-CSF) stem cell mobilisation, CD34 selection of harvested stem cells (in vitro purging), double HDT (cyclophosphamide/epirubicin in the first, busulphan/melphalan in the second) rescued by CD34+-selected cells, the second rescue using cells harvested following the first HDT (in vivo purging) and interferon maintenance.



Results:  Forty-four per cent of patients completed the program. Fifty-three per cent of withdrawals were as a result of insufficient stem cells. This correlated to previous chemotherapy. Therapy-related mortality was 6%. CD34+ selection achieved more than a 2-log reduction of CD38++ cells; in vivo purging achieved 80%. Although similar numbers of CD34+ cells were reinfused at both HDT, platelet recovery was slower after the second HDT. Additional complete remissions were achieved after each phase of therapy, 3% at the end of vincristine, doxorubicin and dexamethasone and 33% after completing planned HDT. Factors associated with longer overall survival included age less than 60 years (P = 0.044), serum β-2-microglobulin below 3 µγ/L at entry (P = 0.042) and less than 2 months between the two HDT (P = 0.024). The only factor associated with a longer event-free survival was less than 2 months between HDT on study (P = 0.038).



Conclusions:  (i) dose intensification with two HDT delivered within 2 months might be associated with a better patient outcome, (ii) early mobilisation should be incorporated in multiple myeloma HDT programs and (iii) higher CD34+ doses may be required for tandem transplants. (Intern Med J 2004; 34: 167−175)

Long-term follow up of sequential mobilisation and autologous transplantation with CD34-selected cells in multiple myeloma: a multimodality approach.

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Long-term follow up of sequential mobilisation and autologous transplantation with CD34-selected cells in multiple myeloma: a multimodality approach.