Myeloablative Conditioning Regimens

A variety of conditioning regimens have been explored using allogeneic transplantation for multiple myeloma. Cyclophosphamide, in combination with TBI or busul-fan, has been used most commonly. No particular regimen has been identified to be superior in terms of CR rates, toxicity, or long-term outcome. As an example, EBMTR studies using a variety of conditioning regimens did not demonstrate any difference in response rates between regimens with or without TBI.1314 Data from FHCRC support this finding: modified TBI added to busulfan and cyclophosphamide did not result in improvement of either relapse or survival of patients transplanted in the setting of advanced disease.20

Melphalan has also been included in the conditioning regimen for allogeneic transplantation. A small study of 14 patients treated with melphalan in addition to busulfan and cyclophosphamide demonstrated a low TRM.22 In another study, 10 of 13 patients receiving melphalan 110-120 mg/m2 in combination with TBI achieved a CR, and 9 patients remained disease free at 7-70 months after transplantation.29 The overall disease-free survival with short follow-up in this study approached 70%.

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