Intermediate-Dose Melphalan (100 mg/m2)/Bortezomib/Thalidomide/Dexamethasone and Stem Cell Support in Patients with Refractory or Relapsed Myeloma

Abstract Background Bortezomib and thalidomide have shown synergy with melphalan and dexamethasone. We used this 4-drug combination as conditioning before autologous hematopoietic cell infusions. Patients and Methods Twenty-six patients with advanced-stage myeloma were treated with melphalan 50 mg/m 2 and bortezomib 1.3 mg/m 2 on days −6 and −3 in association with thalidomide 200 mg and dexamethasone 20 mg on days −6 through −3, followed by hematopoietic cell support on day 0. Results Nonhematologic toxicities included pneumonia, febrile neutropenia, and peripheral neuropathy. All patients had undergone autologous transplantation at diagnosis, and 13 patients (50%) underwent an additional transplantation at relapse. Responses occurred in 17 of 26 patients (65%), including 1 complete remission, 3 near complete remissions (12%), and 2 very good partial remissions (8%). Response rate was higher than that induced by the previous line of treatment in 12 patients (46%). Conclusion Melphalan/bortezomib/thalidomide/dexamethasone showed encouraging antimyeloma activity in patients with advanced-stage myeloma.