High-dose chemotherapy and autologous peripheral blood stem cell transplantation in patients with multiple myeloma and renal insufficiency

Six patients with multiple myeloma and chronic renal insufficiency (serum creatinine >3.0 mg/dl), including four on dialysis, received high-dose busulfan and cyclophosphamide (BUCY) followed by autologous peripheral stem cell transplantation. Peripheral blood stem cells were collected after priming with cyclophosphamide, etoposide and G-CSF, Patterns of engraftment and toxicities were not apparently different from those seen in myeloma patients with normal renal function, There was one toxicity-related death, resulting from a massive spontaneous subdural hematoma, One patient died of disease progression 6 months after transplant, while the remaining four patients are alive and free of myeloma progression 6 to 39 months after high-dose therapy, Two of these patients have remained in complete remission for 28 and 39 months, Our experience suggests that high-dose therapy,vith BUCY and autologous peripheral blood stem cell rescue is feasible in patients with multiple myeloma and renal failure.