WESTPORT, Jan 14 (Reuters Health) - High-dose chemotherapy along with autologous stem cell transplantation prolongs survival in newly diagnosed myeloma patients under the age of 60, compared with those who undergo conventional therapy, researchers from Norway and Sweden report in the January 1st issue of Blood.
Dr. Stig Lenhoff of the University Hospital in Lund, Sweden, and other members of the Nordic Myeloma Study Group treated 274 newly diagnosed, symptomatic myeloma patients with high-dose therapy. All of the patients were under 60 years of age.
The first phase of the experimental protocol consisted of induction therapy with three courses of vincristine, doxorubicin and dexamethasone. Patients subsequently underwent peripheral blood stem cell harvest after receiving cyclophosphamide and granulocyte colony-stimulating factor.
In the third phase, patients received a single intravenous dose of melphalan, 200 mg per meters squared. Forty-eight hours later, they underwent stem cell infusion and received a daily dose of 5 mcg/kg of granulocyte colony-stimulating factor until their absolute neutrophil count stayed above 1,000 per microliter for 3 days. The investigators used interferon alpha-2b, 3 MU per meters squared 3 times a week, as maintenance therapy.
Dr. Lenhoff's group found that survival was significantly longer in the high-dose therapy group than in a group of 274 historical controls who received conventional treatment but met the criteria for high-dose therapy. The investigators add that "...the survival advantage persisted after multivariate analysis of prognostic factors and adjustment for differences between the groups."
The authors note that their results agree with the findings of two other studies. They recommend that "...high-dose therapy should be a part of the initial treatment up to at least 60 years of age."
"Although high-dose therapy may be the first treatment in 30 years that significantly improves survival in younger patients with myeloma," there are some caveats, Dr. Lenhoff and colleagues acknowledge. "First, most patients affected with multiple myeloma (ie, those above 60 to 65 years) are often not considered to be candidates for this treatment because toxicity might be unacceptably high," they write.
In addition, the authors note, "...there is no evidence that patients are cured by this therapy."