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Myeloma

Autologous stem cell transplantation in multiple myeloma after VAD and EDAP courses: a high incidence of oligoclonal serum Igs post transplantation

Bone Marrow Transplantation volume 25, pages 723–728 (2000)Cite this article

Abstract

Thirty-seven patients with multiple myeloma (stage II and III, 65% increased β2-microglobulin level) were prospectively treated with a median of 3.7 VAD courses (range 2–8) followed by cyclophosphamide (6 g/m2) in conjunction with G-CSF (5 μg/kg filgrastrim (n = 14), or 3.5 μg/kg lenograstrim (n = 22)), and peripheral stem cell (PSC) isolation. After regeneration this was followed by one EDAP course and high-dose melphalan (HDM, 200 mg/m2) in combination with re-infusion of PSC. Adequate stem cell mobilization was obtained with both G-CSF regimens. A median of 41 × 106 CD34+ cells/kg (range 4.5–161) was collected in a median of 1.6 leukapheresis procedures following filgrastrim (n = 14) and 24 × 106 CD34+ cells/kg (range 2.3–80) in a median of 1.7 leukapheresis procedures following lenograstrim (n = 22) which indicated no significant difference (P = 0.24) between both G-CSF regimens. A rapid hematological recovery was obtained after HDM with reinfusion of a median of 9.3 × 106 CD34+ cells/kg. After the total courses the overall response was 84% with a complete remission rate of 30%. Currently the median overall survival is 44.0 months (95% CI 38.9–49.1) with a median follow-up of 33 months (range 3–51) and a median event-free survival of 29.0 months (95% CI 25.3–32.7) (n = 33). Post transplantation a high incidence of oligloclonal serum immunoglobulins (Igs) was observed. In 73% of the patients new oligoclonal or monoclonal serum bands were noticed 3 months post transplantation. IgG-λ and IgG-κ bands predominated. In 48% of the cases the oligoclonal Igs disappeared after a median follow-up of 22 months (range 8–36), whereas in 52% of the cases the oligoclonal Igs persisted with a median follow-up of 31 months (range 21–45), which did not correlate with a significant difference in overall, and event-free survival between both subgroups. Bone Marrow Transplantation (2000) 25 , 723–728.

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Acknowledgements

We are grateful to Ruth Egger and the haemopheresis team of the Blood Bank for the continuous support of this study and CA Stegeman for statistical assistance. This study was supported by the Jan Kornelis de Cock Foundation.

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Authors and Affiliations

  1. Department of Hematology, University Hospital Groningen, The Netherlands

    S Hovenga, JThM de Wolf & E Vellenga

  2. Department of Histology and Cell Biology, University Hospital Groningen, The Netherlands

    JEJ Guikema & NA Bos

  3. Department of Immunochemistry, University Hospital Groningen, The Netherlands

    H Klip

  4. Department of Clinical Biochemistry, University Hospital Groningen, The Netherlands

    JW Smit

  5. Blood-bank Noord Nederland, The Netherlands

    CThSmit Sibinga

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  1. S Hovenga
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Hovenga, S., de Wolf, J., Guikema, J. et al. Autologous stem cell transplantation in multiple myeloma after VAD and EDAP courses: a high incidence of oligoclonal serum Igs post transplantation. Bone Marrow Transplant 25, 723–728 (2000). https://doi.org/10.1038/sj.bmt.1702194

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