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Multiple Myeloma

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Dexamethasone

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Fludarabine

Fludarabine phosphate

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Melphalan

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Busulfan

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Interferon-alpha

Interferon alpha-2

4 cycles of alternating chemotherapy VBMCP/VBAD (every 5 weeks). VBMCP: Vcr 2 mg ev day 1, BCNU 0.5 mg/kg ev day 1, Cyclophosphamide 10 mg/kg day 1, Melphalan 0.25 mg/kg v.o. days 1-4, Prednisone 1 mg/kg v.o. days 1-4, 0.5 mg/kg days 5-8 and 0.25 mg/kg days 9-12.

VBAD: Vcr 1 mg e.v. day 1, BCNU 30 mg/m 2 e.v. day 1, Adriamycine 40 mg/m 2 day 1, Dexamethasone 40 mg/m 2 days 1-4, 9-12 and 17-20.

Alternating chemotherapy

Autologous Transplantation :

BUMEL:Busulfan, total dose 12 mg/kg (days -6 a -3; prophylaxis with difenilhidantoine) Melphalan 140 mg/m 2 , ev day -2 TASPE: To investigator criteria

Autologous Transplantation

At 3 months of transplantation or with \>1.500 neutrophiles/ \> 75.000 platelets mm 3 .

Prednisone: 50 mg alternating days during 2 years Interferon alfa 2-b: 3 M UI s.c. Three times a week until relapse.

Maintenance

In cases that no reach CR with BUMEL is programmed second transplantation, after 4-8 months .

Second transplantation

ALOGENIC MINI TRASPLANTATION Fludarabine 30 mg / m 2 / day, days -7, -6, -5, -4, -3 Melphalan 70 mg / m 2 / day, day -2 Prophylaxis EICH: CsA + MTX or CsA + MOFETIL

ALOGENIC MINI TRASPLANTATION

Joan Bladé, Dr

Juan Jose Lahuerta, Dr

Adrián Alegre, Dr

Anna Sureda, Dr

Joaquín Díaz Mediavilla, Dr

Javier De la Rubia, Dr

Joan Bargay, Dr

Jose García-Laraña, Dr

Eulogio Conde, Dr

Felipe Prosper, Dr

The study objectives are to investigate the toxicity and the BUMEL response rate; in patients who reach the CR after autotransplantation, investigate if negativization of IF, influences in disease evolution; in patients in PR after autotransplantation, analyze if the second intensive procedure is capable of increasing the response rate and increasing the survival so that patients who reached the CR with the first transplantation; Patients with MM primarily resistant to the chemotherapy, investigate the efficacy of a double transplantation; patients submitted to double transplantation, control the efficacy of the second transplantation in front of allogenic transplantation.

Pethema Multiple Myeloma 2000

Multiple Myeloma 2000. Multicentric Evaluation of a Therapeutic Strategy Optimized in Multiple Myeloma. Analysis of Efficiency and Possible Pronostic Impact of Minimal Residual Disease (Measured By PCR And Citometry of Flow) in Patients With Complete Response

PETHEMA Foundation

Spots Global Cancer Trial Database for second transplantation