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Allografting

EPOCH-F: a novel salvage regimen for multiple myeloma before reduced-intensity allogeneic hematopoietic SCT

Bone Marrow Transplantation volume 46, pages 676–681 (2011)Cite this article

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Abstract

There exists a need for effective salvage regimens for multiple myeloma patients being considered for reduced-intensity allogeneic hematopoietic SCT (RI-alloHSCT). We developed EPOCH-F, a regimen consisting of infusional etoposide, VCR and adriamycin with prednisone, CY and fludarabine to achieve both tumor control and host lymphocyte depletion to facilitate engraftment before RI-alloHSCT. In all, 22 multiple myeloma patients were treated with EPOCH-F before RI-alloHSCT. The median age was 53 years (range 36–65), and the median number of previous therapies was 2 (range 1–8). Patients received a median of three cycles (range 1–5) of EPOCH-F. Toxicities were primarily hematologic and manageable. Median lymphocyte counts decreased from 1423/μL (range 335–2788) to 519/μL (range 102–1420; P=0.0002). The overall response (⩾PR) to EPOCH-F was 22 with 13% achieving a CR/near-complete response (nCR); only 1 patient progressed while on therapy. A total of 20 patients underwent RI-alloHSCT. Median day +100 donor chimerism was 100% (range 60–100). In all, 70% of patients achieved very good partial response or better response after transplant; 40% of patients achieved CR/nCR. TRM at 100 days and 5 years was 5 and 30%, respectively. Median OS after RI-alloHSCT was 46.1 months. EPOCH-F provides disease control and host lymphocyte depletion with consistent full donor engraftment in multiple myeloma patients undergoing RI-alloHSCT.

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Acknowledgements

This research was supported by the Center for Cancer Research, National Cancer Institute, NIH.

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Authors and Affiliations

  1. Department of Medicine, Division of Hematology and Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC, USA

    S Jamshed

  2. Experimental Transplantation and Immunology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA

    D H Fowler, J Odom, K Bryant, F Hakim & M R Bishop

  3. Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    S S Neelapu

  4. Cleveland Clinic Foundation, Taussig Cancer Center, Cleveland, OH, USA

    R M Dean

  5. Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA

    S M Steinberg

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Jamshed, S., Fowler, D., Neelapu, S. et al. EPOCH-F: a novel salvage regimen for multiple myeloma before reduced-intensity allogeneic hematopoietic SCT. Bone Marrow Transplant 46, 676–681 (2011). https://doi.org/10.1038/bmt.2010.173

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