Clinical Study Of The Efficacy And Safety Of The Three Different Protocols For Multiple Myeloma

Objective: To investigate the efficacy and safety of double autologous peripheral blood stem cell transplantation(APBSCT), bortezomib, and the combination of vincristine, liposomal doxorubicin and dexamethasone with thalidomide in untreated multiple myeloma patients.Methods: Three patients(1 male, 2 females, median age 50.7 yrs, all inⅢA stage by Durie-Salmon stages criteria)with newly diagnosed MM, who were hospitalized in the Second Hospital of Shanxi Medical University from December 2004 to January 2008.The female patient who was 49 years old was treated with double APBSCT after initial cytoreductive chemotherapy with the combination of vincristine, doxorubicin and dexamethasone (VAD). The peripheral blood stem cell (PBSC) mobilization regimen included CTX 2g/m2×1d and G-CSF 10μg·kg-1·d-1×5d. PBSC was collected by COBE Spectra. The number of mono-nucleated cells(MNC) was 6.9×108/kg and 10.8×108/kg, respectively. That of CD34+ cells was 5.5×106/kg and 6.4×106/kg, respectively. PBSC was preserved below 80℃.The condition regimen was melphalan 200mg/m2 orally on days -3 and -2. The duration of the double APBSCT was six months. The transplant number of MNC was 6.1×108/kg and 10.2×108/kg, respectively. That of CD34+ cells was 4.7×106/kg and 5.9×106/kg, respectively. The male patient who was 47 years old received bortezomib 1.3 mg/m2 on days 1, 4, 8, and 11 every 3 weeks. The regimen had repeated for 7 cycles. The female patient who was 56 years old was treated with vincristine 2 mg, liposomal doxorubicin 40 mg/d as single dose on day 1, and dexamethasone 40 mg orally daily on days 1~4 and 9~12. The regimen was administered every 4 weeks for five courses. Thalidomide was given daily at a dose of 100 mg at bedtime. The European Group for Blood and Marrow Transplantation (EBMT) response criteria, as described by Blade, was used to assess the response. Adverse events were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE, version 3.0).Rusults: For the first patient the absolute neutrophil count (ANC) rose to above 0.5×109/L at day +17 and +22, respectively. Platelet count exceeded 20×109/L at day +15 and +13,respectively. The first and second patients were complete response(CR) .The third patient was partial response (PR).The first patient had lapsus pilorum(grade 2), fatigue(grade 2), nausea(grade 3), infection of oral cavity and crissum(grade 3) at the myelosuppression phase after the first transplantation while the patient treated with bortizomib had peripheral neuropathy and herpes zoster infection(grade 2). The patient treated with T-DVD had constipation and neuritis(grade 1).Conclusions: Individualized treatment should be considered for newly diagnosed multiple myeloma patients. Patients presenting with symtomatic myeloma are initially treated with induction chemotherapy followed by high dose therapy and APBCT in suitable patients. Bortezomib is superior to T-DVD therapy for non-transplant candidates .