Abstract

Relapse remains a major problem after a standard ASCT for MM. Strategies to prevent relapse have included post transplant maintenance therapy. M Coleman et al (

Leukemia and Lymphoma
43
:
1777
–1782,
2002
) pioneered a regimen of BLT-D to treat in a non-transplant setting MM and reported a high CR/PR response rate (93%). Since the BLT-D regimen showed significant disease response, it seemed reasonable to study this regimen as maintenance therapy after ASCT. Between 7/2003–1/2006, 23 patients (stage II, n=6 and stage III (n=17) were treated. 26% of patients had poor prognostic cytogenetics. 61% had elevated beta 2 microglobulin at initial diagnosis; 30% still had elevated beta 2 microglobulin at time of ASCT. 48% of the patients had received Thalidomide therapy before ASCT. All were conditioned for ASCT with melphalan 200 mg/m2. 30–120 days after recovery from the acute toxicity of ASCT, patients were treated with Biaxin 250 mg po bid, Dexamethasone 20 mg po q week and Thalidomide beginning at 50 mg po daily for 14 days, then increased to 100 mg po daily. After one year of combination therapy, Biaxin and Dexamethasone were stopped and Thalidomide was continued as long as tolerated or until disease progression. The median time to starting therapy was 102 days (range 40–120) post ASCT. Neuropathy was the most common toxicity. Four patients stopped therapy because of significant peripheral neuropathy and four patients required dose reduction of Thalidomide because of neuropathy. Eight patients had reduction in Dexamethasone dosing because of toxicity. One patient stopped Biaxin for rash. Number of infections seen included pneumonia (n=3), viral upper respiratory infection (n=2), sinusitis (n=1) and bronchitis (n=3). One patient withdrew from therapy to undergo elective second ASCT. Three patients have died: infection (n=1), MM progression (n=1) and complications of second ASCT (n=1). In patients who still had detectable MM after ASCT prior to beginning BLT-D therapy, 46% of the evaluable patients to date have been shown to go into complete remission on BLT-D therapy. Three patients have progressed. 18 (78%) out of 23 patients remain alive without disease progression. Median follow-up is 20.5 months (range 6–25). Further follow-up is needed to determine the effect of BLT-D upon relapse and survival of MM ASCT patients.

Disclosures: Thalidomide, biaxin and dexamethasone as maintenance therapy after ASCT for Multiple Myeloma.; Celgene provided financial support for the study.; Dr. Bensinger received honoraria from Celgene (less than $10,000 total).

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