MELPHALAN PLUS HIGH-DOSE DEXAMETHASONE IN AL PATIENTS WHO ARE NOT CANDIDATES FOR STEM CELL TRANSPLANTATION

摘要

The prognosis of patients with systemic AL is poor, with a median survival of 12-18 months and the main prognostic determinant is amyloid heart involvement (2). At present, therapy of AL is aimed at suppressing the plasma cell done producing the amyloidogenic light-chain. The most effective treatment so far is autologous stem cell transplantation (ASCT), which can induce complete remissions in more than 50% of patients who can undergo this procedure (2, 3). However, a considerable proportion of AL patients is not eligible for ASCT due to advanced disease (3). The patients in whom ASCT is contraindicated are those in greatest need of prompt care. They are usually treated with oral melphalan plus prednisone (MP). However, response rate to this regimen is unsatisfactory and time to response can be unaffordably long. Our previous experience indicated that MP can provide a 37% response rate with a long time to response (median 9 months) (4). Kyle et al. reported that 28% of AL patients respond to MP and 30% of them require to be treated for more than 1 year (5). Time to response to high-dose dexamethasone (HD-Dex) is shorter (median 4 months), but response rate to HD-Dex is still only 35% (6). In an attempt of synergizing the therapeutic actions of melphalan and HD-Dex,we treated with this association 46 patients who were not eligible to ASCT.