Autologous Peripheral-Blood Progenitor-Cell Support Following High-Dose Chemotherapy or Chemoradiotherapy in Patients With High-Risk Multiple Myeloma

Purpose: The aims of the current study were to evalu-ate in patients with high-risk multiple myeloma (MM) the feasibility and usefulness of high-dose chemotherapy or chemoradiotherapy followed by hematopoietic stem-cell support with autologous peripheral-blood progenitor cells (PBPC) harvested after high-dose cyclophospha-mide (HDCYC). Patients and Methods: Seventy-three patients with high-risk MM were entered onto the study. Before the procedure, all patients had received HDCYC to collect PBPC by leukapheresis. One patient died of infection after HDCYC. All other patients subsequently received high-dose melphalan (HDM) (140 mg/m2) either alone (n = 1) or associated with either busulfan (16 mg/kg; n = 4) or total-body irradiation (TBI) (8 to 15 Gy; n = 67). In addition, three of the latter patients received cyclophos-phamide (120 mg/kg). Thereafter, PBPC were reinfused either alone in 61 patients or together with back-up bone marrow cells in 11 patients in whom the granulocyte-macrophage colony-forming unit (CFU-GM) cell content of the leukapheresis was low. Results: One patient died of acute cardiac failure M ULTIPLE MYELOMA (MM) is a malignant dis-ease that involves the B-cell lineage and affects individuals over the age of 50 years. Despite progress in chemotherapy regimens ' and the use of the combination of vincristine, doxorubicin, and dexamethasone (VAD protocol), ' the median survival time is approximately 2 to 4 years. High-dose chemotherapy with alkylating agents such as melphalan (HDM)3 or cyclophosphamid