Bortezomib And High-dose Melphalan As Conditioning Regimen Before Autologous Stem Cell Transplantation In19Patients With Multiple Myeloma

Objective:To evalute the safety and clinical efficacy of the conditioning regimen composed with bortezomib and high dose melphalan in patients of multiple myeloma (MM) who received autologous hematopoietic stem cell transplantation (ASCT).Methods:19patients with MM were admitted who received ASCT in our center using high-dose CTX combined with G-CSF to mobilize peripheral blood stem cells and choosing bortezomib and high dose melphalan (Velcade lmg/m2-6,-3,+1,+4d; melphalan140mg/mz-2d) as conditioning regimen from December2007to October2011. The overall survival (OS), progression-free survival (PFS), transplantation-related mortality (TRM) were analyzed.Results:(1)18patients got hematopoietic recovery successfully. While1case failed in platelet recovery primarily with neutrophil recovery at19days after transplantation, who finally got recovery after reinfusion of autologous stem cell at7months after ASCT. Median time of neutrophil recovery (≥0.5×109/L) and platelet recovery (≥20×109/L) was14(12-19) days and14(9-∞) days respectively. The main transplant-related incidence was infectious fever, and there is9cases totally (2pneumonia,1diarrhea and1gingivitis, fully reversible after hematopoietic recovery and supportive therapy. The transplant-related mortality was0.(2) Assessment was taken away one month after transplantation.13cases got CR (68.42%), and6cases got VGPR (31.58%), with an overall response rate of100%. Median follow-up time was22(4-51) months.8cases (42.11%) relapsed,4cases of whom progressed and1case died at4months after ASCT due to disease progression.1-year OS and3-year OS were94%and94%respectively,1-year PFS and3-year PFS were84%and82%respectively. The median overall survival (OS) period and progression-free survival (PFS) period are not available yet.(3) There was no significant difference in2-year PFS and OS between the subgroups which got CR before transplantation or not(VGPR or PR). So was the3-year PFS and OS between the subgroups using bortezomib during the initial therapy regimen or not.Conclusions:Bortezomib and high-dose melphalan as conditioning regimen before autologous stem cell transplantation is safe and effective for the patients with multiple myeloma. Further studies are still required to define whether this regimen improves long-term’s survival.