Canterbury DHB
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Outcomes after high dose melphalan (HDM) followed by autologous transplantation are highly variable, probably due to patient selection in single centre studies. The only randomised trial comparing HDM with chemotherapy (Melphalan-dexamethasone) was heavily skewed by the very high transplant-related mortality (TRM 24%). Peripheral blood cell mobilisation can be associated with higher morbidity than in myeloma, even with G-CSF alone. HDM is feasible in patients with end-stage disease using dose splitting and dialysis.
A major predictor of survival is the extent of cardiac functional compromise as measured by cardiac troponin-T and NT-proBNP. Patients who have significant elevations of both cardiac biomarkers have a median survival of only 3.5 months. If 1 cardiac biomarker is significantly elevated, the median survival is only 10.5 months. (Gertz 2010)
There is a high rate of arrhythmias during HDM and telemetry is recommended. Renal toxicity is high with up to 20% acute kidney injury in patients with pre-existing renal involvement.
There is limited data on allogeneic transplantation which cannot be recommended outside clinical trials (Comenzo, 2009).
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Topic Code: 8155
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