Comparable outcomes using propylene glycol-free melphalan for autologous stem cell transplantation in multiple myeloma

Bone Marrow Transplant. 2019 Apr;54(4):587-594. doi: 10.1038/s41409-018-0302-6. Epub 2018 Aug 16.

Abstract

Autologous stem cell transplantation (ASCT) remains a mainstay in the treatment of multiple myeloma (MM). While the procedure is generally safe, toxicities associated with high-dose melphalan conditioning are common and significantly affect patient quality of life. Recently, a propylene glycol-free melphalan formulation (PG-free MEL; Evomela®) was approved by the United States Food and Drug Administration as an ASCT-conditioning regimen for MM. PG-free MEL is more soluble and stable than propylene glycol-solubilized melphalan (PG-solubilized MEL; Alkeran®). As such, there is speculation that it could decrease toxicities and increase the efficacy of ASCT. We compared the outcomes of patients conditioned with PG-free MEL (n = 216) to PG-solubilized MEL (n = 200) at our institution. The baseline characteristics were similar between the two groups. After Day +0, there were no differences in terms of hospitalizations, neutropenic fevers, intravenous granisetron requirement, World Health Organization grade ≥ 2 oral/esophageal mucositis, intravenous fluid requirement, or narcotic requirement. However, PG-free MEL patients had a higher incidence of diarrhea, which was mostly C. difficile-negative (82% vs. 71%, P = 0.015*). Day + 100 hematologic responses and progression-free survival after ASCT were comparable. In summary, we demonstrate that switching to PG-free MEL did not significantly reduce short-term complications of ASCT or improve outcomes in MM.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Female
  • Hematopoietic Stem Cell Transplantation / methods*
  • Humans
  • Male
  • Melphalan / pharmacology
  • Melphalan / therapeutic use*
  • Multiple Myeloma / drug therapy*
  • Transplantation Conditioning / methods*
  • Transplantation, Autologous / methods*
  • Treatment Outcome

Substances

  • Melphalan