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

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    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
    Show allShow less
    Affiliation
    Department of Haematology, University College London Hospitals NHS Trust, London, UK. shirley.dsa@uclh.nhs.uk
    Issue Date
    2004-06
    
    Metadata
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    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.
    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
    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
    ae974a485f413a2113503eed53cd6c53
    10.1111/j.1365-2141.2004.04981.x
    Scopus Count
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