Total Marrow Irradiation: A New Ablative Regimen as Part of Tandem Autologous Stem Cell Transplantation for Patients with Multiple Myeloma
- 1 January 2011
- journal article
- clinical trial
- Published by American Association for Cancer Research (AACR) in Clinical Cancer Research
- Vol. 17 (1), 174-182
- https://doi.org/10.1158/1078-0432.ccr-10-1912
Abstract
Purpose: To establish feasibility, maximum tolerated dose (MTD), and potential efficacy of ablative dose total marrow irradiation (TMI) delivered by helical tomotherapy in patients with multiple myeloma (MM). Experimental Design: Patients with responding or stable MM received tandem autologous stem cell transplants, first with melphalan 200 mg/m2, and 60 days or later with TMI. TMI doses were to be escalated from 1,000 cGy by increments of 200 cGy. All patients received thalidomide and dexamethasone maintenance. Results: Twenty-two of 25 enrolled patients (79%) received tandem autologous stem cell transplantation (TASCT): TMI was administered at a median of 63.5 days (44–119) after melphalan. Dose-limiting toxicities at level 5 (1,800 cGy) included reversible grade 3 pneumonitis, congestive heart failure, and enteritis (1), and grade 3 hypotension (1). The estimated median radiation dose to normal organs was 11% to 81% of the prescribed marrow dose. Late toxicities included reversible enteritis (1), and lower extremity deep venous thrombosis during maintenance therapy (2). The complete and very good partial response rates were 55% and 27% following TASCT and maintenance therapy. At a median of 35 months of follow-up (21–50+ months), progression-free and overall survival for all patients were 49% (95% CI, 0.27–0.71) and 82% (0.67–1.00). Conclusion: Ablative dose TMI as part of TASCT is feasible, and the complete response rate is encouraging. Careful monitoring of late toxicities is needed. Further assessment of this modality is justified at the 1,600 cGy MTD level in MM patients who are candidates for ASCT. Clin Cancer Res; 17(1); 174–82. ©2010 AACR.Keywords
This publication has 42 references indexed in Scilit:
- Lenalidomide, bortezomib, and dexamethasone combination therapy in patients with newly diagnosed multiple myelomaBlood, 2010
- Long-Term Follow-Up of Autotransplantation Trials for Multiple Myeloma: Update of Protocols Conducted by the Intergroupe Francophone du Myelome, Southwest Oncology Group, and University of Arkansas for Medical SciencesJournal of Clinical Oncology, 2010
- Lenalidomide plus dexamethasone versus thalidomide plus dexamethasone in newly diagnosed multiple myeloma: a comparative analysis of 411 patientsBlood, 2010
- Achievement of at Least Very Good Partial Response Is a Simple and Robust Prognostic Factor in Patients With Multiple Myeloma Treated With High-Dose Therapy: Long-Term Analysis of the IFM 99-02 and 99-04 TrialsJournal of Clinical Oncology, 2009
- Multicenter, Phase I, Dose-Escalation Trial of Lenalidomide Plus Bortezomib for Relapsed and Relapsed/Refractory Multiple MyelomaJournal of Clinical Oncology, 2009
- Cancer stem cells in multiple myelomaCancer Letters, 2008
- Bortezomib plus Melphalan and Prednisone for Initial Treatment of Multiple MyelomaNew England Journal of Medicine, 2008
- High-dose melphalan-based autotransplants for multiple myelomaCancer, 2008
- A Comparison of Allografting with Autografting for Newly Diagnosed MyelomaNew England Journal of Medicine, 2007
- Single versus Double Autologous Stem-Cell Transplantation for Multiple MyelomaNew England Journal of Medicine, 2003