Efficacy, toxicity and feasibility of a shorter schedule of DCEP regimen for stem cell mobilization in multiple myeloma

• Published in: Bone marrow transplantation (Basingstoke) Vol. 36; no. 11; pp. 951 - 954
• Main Authors: CORSO, A, MANGIACAVALLI, S, TROLETTI, D, PASCUTTO, C, MORRA, E, LAZZARINO, M, NOSARI, A, CASTAGNOLA, C, ZAPPASODI, P, CAFRO, A. M, ASTORI, C, BONFICHI, M, VARETTONI, M, RUSCONI, C
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01-12-2005
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anticancer properties; Antigens, CD34 - analysis; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - toxicity; Antitumor activity; Biological and medical sciences; Bone marrow, stem cells transplantation. Graft versus host reaction; Care and treatment; CD34 antigen; Cisplatin; Cisplatin - administration & dosage; Cyclophosphamide; Cyclophosphamide - administration & dosage; Dexamethasone; Dexamethasone - administration & dosage; Diagnosis; Dosage and administration; Drug Administration Schedule; Etoposide; Etoposide - administration & dosage; Feasibility Studies; Hematopoietic Stem Cell Mobilization - methods; Humans; Immunodeficiencies. Immunoglobulinopathies; Immunoglobulinopathies; Immunopathology; Infection - chemically induced; Medical sciences; Melphalan; Multiple myeloma; Multiple Myeloma - complications; Multiple Myeloma - therapy; Neutropenia; Neutropenia - chemically induced; Patient outcomes; Peripheral Blood Stem Cell Transplantation - adverse effects; Peripheral Blood Stem Cell Transplantation - methods; Retrospective Studies; Schedules; Statistical analysis; Stem cell transplantation; Stem cells; Thrombocytopenia; Thrombocytopenia - chemically induced; Toxicity; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Italy; Antineoplastic agent; Toxicity; Stem cell; Hematopoietic cell; Administration schedule; Myeloma; Glucocorticoid; Autograft; Isomerases; Immunoglobulinopathy; Lymphoproliferative syndrome; Graft; Complication; Antimitotic; Platinum II Complexes; Human; Corticosteroid; DNA topoisomerase (ATP-hydrolysing); Immunopathology; Dexamethasone; Hematology; Enzyme; Treatment efficiency; Enzyme inhibitor; Etoposide; Malignant hemopathy; Cisplatin; Podophyllotoxine derivatives; Mobilization; Alkylating agent; Oxazaphosphinane derivatives; Chemotherapy; Treatment; DCEP; peripheral stem cells; Nitrogen mustard; Therapeutic protocol
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1705166

From 2000 to 2004, 152 patients with multiple myeloma aged <or=65 years, enrolled in high-dose programs, were treated with two schedules of DCEP (dexamethasone, cyclophosphamide, etoposide, and cisplatin): 106 patients (group I) were mobilized with the infusional version of DCEP (infusional-DCEP), and 46 patients (group II) with a shorter version (DCEP-short). The median number of CD34(+) cells collected was similar in the two groups as was the percentage of patients yielding >or=4 x 10(6) cells/kg. The proportion of patients in whom mobilization failed was similar in the two groups. The incidence of WHO grade III neutropenia was higher in group II, although the difference was not statistically significant; the percentage of patients requiring hospitalization for severe infections was similar in the two groups. The incidence of WHO grade IV thrombocytopenia did not differ between the two groups. The response rate was 72% in group I and 80% in group II with similar percentages of patients achieving good responses. DCEP-short is a good mobilizing regimen, sharing the same characteristics as infusional-DCEP: high mobilizing efficacy, low toxicity and good antitumor activity. This new schedule of DCEP does, however, allow complete outpatient management and so could be advantageously included in any high-dose therapy program.