Search

L-phenylalanine mustard (L-PAM) is one of the most active agents for multiple myeloma (MM). The maximum tolerable dose of L-PAM is 240 mg/m 2 and less is used in combinations with busulfan or total body irradiation. The usual dose is 200 mg/m 2 followed by a stem cell (SC) infusion. We have performed a feasibility study to determine if 3 cycles of L-PAM (followed by autologous SC on the next day) could be delivered at 100 mg/m 2 at 3-week intervals on an outpatient basis. Three patients (pts) with chemoresponsive, stage III MM had peripheral blood SC mobilized with cyclophosphamide, prednisone and G-CSF. After CD34+ cell selection, SC were frozen in 3 aliquots. A backup SC collection was also cryopreserved. G-CSF was started day +1 and trovafloxacin and fluconazole were started day +5 after SC infusion. Of the 9 cycles, 1 cycle was delayed 1 week because of a central venous access line infection and there were 5 admissions: 3 for neutropenic fever and 1 each for mild enteritis and disseminated Herpes zoster. For pt 3, delayed ANC recoveries were seen despite acceptable numbers of CD34+ cells infused; for course 3, back-up SC were given when recovery appeared to be late and prompt engraftment ensued. All 3 pts showed reduction in their M-proteins. Next, pt 1 received alpha-interferon and pt 2 received thalidomide but pt 3 is TE. These 3 patients demonstrate that 300 mg/m 2 L-PAM can be delivered with ANC recovery in a space of 9 weeks with acceptable non-marrow toxicities.