Etoposide, methylprednisolone, cytarabine and cisplatin successfully cytoreduces resistant myeloma patients and mobilizes them for transplant without adverse effects.

2.50
Hdl Handle:
http://hdl.handle.net/10541/77839
Title:
Etoposide, methylprednisolone, cytarabine and cisplatin successfully cytoreduces resistant myeloma patients and mobilizes them for transplant without adverse effects.
Authors:
D'Sa, Shirley; Yong, Kwee; Kyriakou, Chara; Bhattacharya, Soumo; Peggs, Karl S; Foulkes, Barbara; Watts, Michael J; Ings, Stuart J; Ardeshna, Kirit M; Goldstone, Anthony H; Williams, Catherine D
Abstract:
Myeloma remains incurable with a median survival of 4 years, but outcome can be improved by the use of high-dose therapy. We used the etoposide, methylprednisolone, cytarabine and cisplatin (ESHAP) regimen as second-line therapy in 42 newly diagnosed myeloma patients who had failed vincristine, adriamycin and dexamethasone (VAD)- type therapy (n = 36), responded to first-line treatment but persisted in having significant residual marrow plasmacytosis (n = 5) or failed prior stem cell harvesting (n = 1), with the dual aim of improving disease response and mobilizing peripheral blood stem cells. Fourteen of 21 (67%) patients with no change or progressive disease after VAD responded to ESHAP; seven of 12 (58%) patients with minor response converted to partial response. Marrow plasmacytosis fell from a median of 52% at diagnosis to 23.5% after primary therapy and to15% after ESHAP. ESHAP chemotherapy was well-tolerated. There were 11 admissions due to febrile neutropenia (n = 7), nausea and vomiting (n = 2), pneumonia (n = 1) and perforated bowel (n = 1). Renal function deteriorated in 13 of 42 patients after ESHAP, but none required renal support. ESHAP mobilization was performed in 32 patients of whom 87% achieved a CD34(+) yield >2 x 10(6)/kg. In all, 38 patients proceeded to high-dose therapy. The overall survival for all patients was 62% at 4 years following ESHAP. We conclude that ESHAP has acceptable toxicity and efficient stem cell mobilizing capability, effectively cytoreduced this chemoresistant group of patients, and did not appear to adversely affect transplant outcome.
Affiliation:
Department of Haematology, University College London Hospitals NHS Trust, London, UK. shirley.dsa@uclh.nhs.uk
Citation:
Etoposide, methylprednisolone, cytarabine and cisplatin successfully cytoreduces resistant myeloma patients and mobilizes them for transplant without adverse effects. 2004, 125 (6):756-65 Br. J. Haematol.
Journal:
British Journal of Haematology
Issue Date:
Jun-2004
URI:
http://hdl.handle.net/10541/77839
DOI:
10.1111/j.1365-2141.2004.04981.x
PubMed ID:
15180865
Type:
Article
Language:
en
ISSN:
0007-1048
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorD'Sa, Shirley-
dc.contributor.authorYong, Kwee-
dc.contributor.authorKyriakou, Chara-
dc.contributor.authorBhattacharya, Soumo-
dc.contributor.authorPeggs, Karl S-
dc.contributor.authorFoulkes, Barbara-
dc.contributor.authorWatts, Michael J-
dc.contributor.authorIngs, Stuart J-
dc.contributor.authorArdeshna, Kirit M-
dc.contributor.authorGoldstone, Anthony H-
dc.contributor.authorWilliams, Catherine D-
dc.date.accessioned2009-08-19T11:33:03Z-
dc.date.available2009-08-19T11:33:03Z-
dc.date.issued2004-06-
dc.identifier.citationEtoposide, methylprednisolone, cytarabine and cisplatin successfully cytoreduces resistant myeloma patients and mobilizes them for transplant without adverse effects. 2004, 125 (6):756-65 Br. J. Haematol.en
dc.identifier.issn0007-1048-
dc.identifier.pmid15180865-
dc.identifier.doi10.1111/j.1365-2141.2004.04981.x-
dc.identifier.urihttp://hdl.handle.net/10541/77839-
dc.description.abstractMyeloma remains incurable with a median survival of 4 years, but outcome can be improved by the use of high-dose therapy. We used the etoposide, methylprednisolone, cytarabine and cisplatin (ESHAP) regimen as second-line therapy in 42 newly diagnosed myeloma patients who had failed vincristine, adriamycin and dexamethasone (VAD)- type therapy (n = 36), responded to first-line treatment but persisted in having significant residual marrow plasmacytosis (n = 5) or failed prior stem cell harvesting (n = 1), with the dual aim of improving disease response and mobilizing peripheral blood stem cells. Fourteen of 21 (67%) patients with no change or progressive disease after VAD responded to ESHAP; seven of 12 (58%) patients with minor response converted to partial response. Marrow plasmacytosis fell from a median of 52% at diagnosis to 23.5% after primary therapy and to15% after ESHAP. ESHAP chemotherapy was well-tolerated. There were 11 admissions due to febrile neutropenia (n = 7), nausea and vomiting (n = 2), pneumonia (n = 1) and perforated bowel (n = 1). Renal function deteriorated in 13 of 42 patients after ESHAP, but none required renal support. ESHAP mobilization was performed in 32 patients of whom 87% achieved a CD34(+) yield >2 x 10(6)/kg. In all, 38 patients proceeded to high-dose therapy. The overall survival for all patients was 62% at 4 years following ESHAP. We conclude that ESHAP has acceptable toxicity and efficient stem cell mobilizing capability, effectively cytoreduced this chemoresistant group of patients, and did not appear to adversely affect transplant outcome.en
dc.language.isoenen
dc.subjectHaematopoietic Stem Cell Mobilizationen
dc.subject.meshAdult-
dc.subject.meshAged-
dc.subject.meshAntineoplastic Combined Chemotherapy Protocols-
dc.subject.meshCell Count-
dc.subject.meshCisplatin-
dc.subject.meshCytarabine-
dc.subject.meshDose-Response Relationship, Drug-
dc.subject.meshEtoposide-
dc.subject.meshFemale-
dc.subject.meshHematopoietic Stem Cell Mobilization-
dc.subject.meshHumans-
dc.subject.meshMale-
dc.subject.meshMethylprednisolone-
dc.subject.meshMiddle Aged-
dc.subject.meshMultiple Myeloma-
dc.subject.meshPlasma Cells-
dc.titleEtoposide, methylprednisolone, cytarabine and cisplatin successfully cytoreduces resistant myeloma patients and mobilizes them for transplant without adverse effects.en
dc.typeArticleen
dc.contributor.departmentDepartment of Haematology, University College London Hospitals NHS Trust, London, UK. shirley.dsa@uclh.nhs.uken
dc.identifier.journalBritish Journal of Haematologyen

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