{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T02:50:05Z","timestamp":1761101405988},"reference-count":0,"publisher":"American Society of Hematology","issue":"3","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[1994,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>One hundred and thirty-five patients with advanced and refractory myeloma received one of three high-dose therapy regimens: melphalan at doses of 90 to 100 mg\/m2 (MEL 100; 47 patients) without autotransplant; total body irradiation (TBI; 850 cGy) with either melphalan 140 mg\/m2 or thiotepa 750 mg\/m2 and autologous bone marrow transplant (ABMT) (&lt; or = 30% plasma cells; 21 patients); melphalan 200 mg\/m2 (MEL 200) supported by both peripheral blood stem cells (PBSC) and ABMT plus GM- CSF intended as a double-transplant program (67 patients; 42 have completed and 3 are still awaiting a second autotransplant; 5 additional patients received an allograft for their second transplant). Mortality within 2 months of therapy was 20% to 25% with MEL 100 and TBI regimens, but less than 1% with MEL 200, mainly because severe neutropenia (&lt; 500\/microL) was shortened to less than 1 week due to infusion of PBSC and use of growth factor therapy. Low beta 2- microglobulin (beta 2M) levels &lt; or = 2.5 mg\/L and MEL 200 therapy were identified as the two most important independent favorable variables associated with prolonged event-free survival (EFS) and overall survival (OS). On the basis of these two parameters, three risk groups were defined: 29 good-risk patients with low beta 2M receiving MEL 200 had the best outcome, with median durations of EFS of 37 months and projected OS of &gt; or = 43 months; 54 intermediate-risk patients displaying one of the two favorable parameters had EFS and OS durations of 16 and 36 months, respectively; and 52 poor-risk patients with high beta 2M not receiving MEL 200 had a dismal prognosis, with EFS of 3 months and OS of 5 months (all P &gt; .0001). Further analysis that excluded treatment as a variable identified high beta 2M and resistant relapse as the two major adverse prognostic factors, one of which was present in 80% of the 135 patients. Among these 108 high-risk patients, prognosis was improved markedly with MEL 200 because of both better supportive care (PBSC and hematopoietic growth factors) and more intensive therapy using the double-transplant approach. This study supports the concept that safer and potentially more-effective therapies can be developed in the setting of advanced and resistant disease.<\/jats:p>","DOI":"10.1182\/blood.v84.3.950.950","type":"journal-article","created":{"date-parts":[[2019,10,14]],"date-time":"2019-10-14T01:41:12Z","timestamp":1571017272000},"page":"950-956","update-policy":"http:\/\/dx.doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":112,"title":["High-dose therapy for refractory multiple myeloma: improved prognosis with better supportive care and double transplants"],"prefix":"10.1182","volume":"84","author":[{"given":"DH","family":"Vesole","sequence":"first","affiliation":[{"name":"Division of Hematology\/Oncology, University of Arkansas for Medical Sciences, Little Rock 72205."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B","family":"Barlogie","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, University of Arkansas for Medical Sciences, Little Rock 72205."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Jagannath","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, University of Arkansas for Medical Sciences, Little Rock 72205."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B","family":"Cheson","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, University of Arkansas for Medical Sciences, Little Rock 72205."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G","family":"Tricot","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, University of Arkansas for Medical Sciences, Little Rock 72205."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R","family":"Alexanian","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, University of Arkansas for Medical Sciences, Little Rock 72205."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Crowley","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, University of Arkansas for Medical Sciences, Little Rock 72205."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"234","container-title":["Blood"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/ashpublications.org\/blood\/article-pdf\/84\/3\/950\/616181\/950.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/ashpublications.org\/blood\/article-pdf\/84\/3\/950\/616181\/950.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,11,20]],"date-time":"2019-11-20T10:42:29Z","timestamp":1574246549000},"score":1,"resource":{"primary":{"URL":"https:\/\/ashpublications.org\/blood\/article\/84\/3\/950\/172093\/Highdose-therapy-for-refractory-multiple-myeloma"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1994,8,1]]},"references-count":0,"journal-issue":{"issue":"3","published-print":{"date-parts":[[1994,8,1]]}},"URL":"https:\/\/doi.org\/10.1182\/blood.v84.3.950.950","relation":{},"ISSN":["0006-4971","1528-0020"],"issn-type":[{"value":"0006-4971","type":"print"},{"value":"1528-0020","type":"electronic"}],"subject":[],"published":{"date-parts":[[1994,8,1]]}}}