Imaging in Stem Cell Transplant and Cell-based Therapy

78

5.2.4 ASCT in Relapsed MM

In relapsed MM, HD­chemotherapy with ASCT is an established treatment regimen
that needs to be considered in any physically fit patients. The Scandinavian myeloma
research groups have recently published clear evidence underlining the importance
of ASCT in the setting of relapsed disease. Patients who relapsed after first HDC
and ASCT received either a second ASCT, novel anti­myeloma agents or conven­
tional chemotherapy, respectively: the OS was 4 years in the ASCT­salvage group
compared to 3.3 years in group treated with novel drugs (p < 0.001) and 2.5 years
for those treated receiving conventional chemotherapy (p  <  0.001) [ 46 ]. In the

Total Therapy 1 Total Therapy^2

a: with THAL

b: without THAL

Total Therapy 3a

Induction Induction Induction

VAD (3 cycles)

+

HD-cyclophosphamide

+ collection of stem cells (CD34+)

+

EDAP (1 cycle)

ASCT

MEL 200 mg/m2

MEL 200 mg/m2

VAD (1 cycle)

+

DCEP (1 cycle)

+

CAD (1 cycle) + collection of stem

cells (CD34+)

+

DCEP (1 cycle)

ASCT

MEL 200 mg/m2

MEL 200 mg/m2

Consolidation

VAD (1 cycle)

+

DCEP (1 cycle)

+

CAD (1 cycle)

+

DCEP (1 cycle)

Maintenance

1 styear: DEX + IFN

2 nd+ 3rdyear: IFN

Maintenance

IFN

ASCT

MEL 200 mg/m2

MEL 200 mg/m2

Consolidation

VDT-PACE (2 cycles)

VDT-PACE (2 cycles)

+ collection of stem cells (CD34+)

with 1stcycle of VDT-PACE

Maintenance

1 styear: VDT

2 nd+ 3rdyear: DT

Fig. 5.2. Overview of Total Therapy (TT) trials, TT1, TT2a and b, TT3a. VAD: vincristine,
adriamycin, dexamethasone, HD: high­dose, EDAP: etoposide, dexamethasone, adriamycin,
cisplatin, MEL: melphalan, IFN: interferon, DCEP: dexamethasone, cyclophosphamide, etopo­
side, cisplatin, CAD: cyclophosphamide, adriamycin, dexamethasone, DEX: dexamethasone,
VDT­PACE: bortezomib, dexamethasone, thalidomide, cisplatin, adriamycin, cyclophosphamide,
etoposide, VDT: bortezomib, thalidomide, dexamethasone, DT: dexamethasone, thalidomide

S. Thanendrarajan and T.K. Garg