{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T17:18:43Z","timestamp":1787678323543,"version":"build-2784847793"},"reference-count":27,"publisher":"International Union Against Tuberculosis and Lung Disease","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["public health action"],"accepted":{"date-parts":[[2026,5,17]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>High-dose melphalan\u2013based autologous stem cell transplantation (ASCT) remains a cornerstone of treatment in multiple myeloma but causes severe gastrointestinal toxicity in up to 50% of patients due to mucosal injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To mitigate this, we assessed a multimodal approach of combined oral cryotherapy, extended duration of melphalan infusion (1 h compared to bolus), and upright patient positioning during administration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DESIGN<\/jats:title>\n                    <jats:p>A cohort study using hospital patient records to evaluate the safety and outcomes of this approach at a tertiary hospital in South India, from January 2017 to March 2026.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among 47 patients undergoing ASCT, 4% had grade 3 (severe) mucositis, 15% experienced grade 3 diarrhoea, and one patient had severe vomiting. No grade 4 (life threatening) or grade 5 (fatal) gastrointestinal toxicities were observed. Total parenteral nutrition was required in 4% patients. The median duration of stay in the transplant unit was 14 days. There was no post-transplant mortality within 1 year. Relapse-free survival at 1 year was 88%, and relapse was significantly associated with high-risk cytogenetics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Multimodal melphalan delivery is feasible, with manageable toxicity and low rates of severe adverse events, while maintaining excellent short-term outcomes. Further multicentric evaluation and wider adoption is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.5588\/pha.26.0046","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T16:23:46Z","timestamp":1787675026000},"page":"216-221","source":"Crossref","is-referenced-by-count":0,"title":["Multimodal melphalan delivery: improved safety and outcomes with autologous myeloma transplant in 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