Total Therapy 1

Multiple Myeloma

Induction phase

• Cycles 1-3, VAD Vincristine (0.5 mg/d x 4 d) CI; Adriamycin (10 mg/m2/d x 4 d) CI; Dexamethasone 40 mg PO d 1-4, 9-12, 17-20
• Cycle 4, HD-CTX Cyclophosphamide (6 g/m2 in 5 divided doses, 1.2 g/m2 every 3 h) + Mesna (3.6 g/m2); GM-CSF 250 µg/m2/d -> PBSC collection
• Cycle 5, EDAP Etoposide (100 mg/m2/d x 4 d) CI; cis-Platin (25 mg/m2/d x 4 d)Arabinosyl-cytosine (1 g/m2 d 5); Dexamethasone 40 mg d 1-5; GM-CSF 250 µg/m2/d

Transplantation phase

• First transplantation Melphalan (100 mg/m2 on d -3 and -2); PBSC d 0; GM-CSF 250 µg/m2/d
• Second transplantation Melphalan (100 mg/m2 on d -3 and -2); PBSC d 0; GM-CSF 250 µg/m2/d; (In case of < PR: melphalan 140 mg/m2 plus total body irradiation 8.5 Gy in 5 equal fractions of 1.7 Gy every 12 h)

Maintenance phase

• Interferon 3 million U/m2 SQ 3 x wk until relapse

References

Barlogie et. al. Total Therapy With Tandem Transplants for Newly Diagnosed Multiple Myeloma Blood, Vol. 93 No. 1 (January 1), 1999: pp. 55-65