Bortezomib after dose-reduced allogeneic stem cell transplantation for multiple myeloma to enhance or maintain remission status

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• 作者：Nicolaus Krö ; ger ; Tatjana Zabelina ; Francis Ayuk ; Djordje Atanackovic ; Heike Schieder ; Helmut Renges and Axel Zander
• 刊名：Experimental Hematology
• 出版年：2006
• 出版时间：June 2006
• 年：2006
• 卷：34
• 期：6
• 页码：770-775
• 全文大小：107 K

文摘

Objective

We investigated the effect of at least two cycles of bortezomib (1.3 mg/m² intravenously, days 1, 4, 8, and 11) after dose-reduced allogeneic stem cell transplantation (SCT) on toxicity, CD3⁺ cells, graft-versus-host disease (GvHD), and response in patients with multiple myeloma.

Methods

Eighteen patients with multiple myeloma without progressive disease were included. The proteasome inhibitor was given at median of 8 months after allografting to enhance or maintain remission status.

Results

Fourteen patients (78 % ) completed the proposed two cycles. Four patients had to discontinue therapy due to neurotoxicity (n = 3) or gastrointestinal toxicity (n = 1). Severe grade III/IV toxicity was seen for thrombocytopenia (50 % ), leukopenia (17 % ), or neuropathy (17 % ), which was more often seen in patients treated concomitantly with cyclosporine (p = 0.06). The median circulating CD3⁺ cells decreased during treatment from 550 μL to 438 μL (p = 0.03), resulting in herpes zoster infection in three patients (17 % ). In three patients, a mild aggravation of existing acute or chronic GvHD of the skin, and in one patient de novo skin grade I acute GvHD was noted. In patients with measurable disease, complete remission, partial remission, and minor response was seen in 3 (30 % ), 5 (50 % ), and 2 (20 % ) patients, respective.

Conclusion

Bortezomib after allogeneic SCT is effective but further studies are needed to balance the efficacy with potential hazards such as infectious complications, aggravation of GvHD, and neurotoxicity.