Satoshi Noto

Bortezomib, Dexamethasone, and High-Dose Melphalan as Conditioning for Stem Cell Transplantation in Young Japanese Multiple Myeloma Patients: A Pilot Study

Autologous stem cell transplantation is recommended for younger patients with newly diagnosed multiple myeloma because of a high complete response rate and better survival. Bortezomib shows a synergistic effect with melphalan and has no prolonged hematologic toxicity, and the complete response rate after autologous stem cell transplantation is improved by combining bortezomib with melphalan for conditioning. Twelve patients were enrolled in a phase 2 study between February and November 2010, receiving bortezomib (1xa0mg/m2xa0×xa04), dexamethasone (20xa0mg/bodyxa0×xa08), and melphalan (200xa0mg/m2) for conditioning. No toxic deaths occurred. Neutrophils (absolute neutrophil count ≥0.5xa0×xa0109/L) and platelets (≥20xa0×xa0109/L without transfusion) recovered after a median of 5xa0days (range: 4–6xa0days) and 7xa0days (range: 4–8xa0days), respectively. No patient was admitted for exacerbation of peripheral neuropathy. Four patients obtained a stringent complete response, three patients obtained a complete response, and three patients showed a very good partial response. These results suggest that this conditioning regimen is safe and promising for young Japanese multiple myeloma patients. A prospective multicenter trial of this regimen combined with suitable induction and consolidation therapy should be performed.

Achievement of deep molecular response in an elderly chronic myeloid leukemia patient intolerant to imatinib and nilotinib

A 90-year-old woman was diagnosed with chronic myeloid leukemia (CML) of the high risk type (Sokal score 1.5), and was administered imatinib (400 mg/day). However, imatinib had to be switched to nilotinib because she suffered persistent vomiting and nausea. Although a cytogenetic response was achieved, the nilotinib administration also had to be stopped because the patient developed QTc prolongation and heart failure. After she had recovered from heart failure, the patient was given dasatinib (50 mg/day). No non-hematological adverse events occurred and she achieved a molecular response with administration of dasatinib. A molecular response can be achieved through appropriate supportive care and careful selection of tyrosine kinase inhibitors, with adjustments in the doses of these drugs administered to patients with the high-risk form of CML who are intolerant to imatinib.