－S 311 －
￭ S-497 ￭
Optimal treatment timing of CMV viremia patients after hematopoietic stem-cell transplantation
Division of Hematology, Department of Internal Medicine, College of Medicine, Yonsei University
*Shin Young Hyun, Hyun Sung Park, Soo Jeong Kim, Jin Seok Kim, June Won Cheong, Yoo Hong Min
Background: Cytomegalovirus (CMV) infection influences the prognosis of hematopoietic stem cell transplantation (HSCT). Pre-emptive ganciclovir therapy is widely used to prevent organ damage. However, there are no guidelines on when to start preemptive therapy. We investigated when best to initiate pre-emptive treatment. Methods: We studied the 138 patients who underwent allogenic HSCT at Severance Hospital between 2005 and 2009 retrospectively. Of these, 81 patients (58.7%) were positive for CMV on qualitative PCR (QL-PCR).
Twenty-eight of these patients were excluded: 21 patients did not receive anti-CMV treatment, 4 patients did not complete the 2 week treatment, and 3 patients were treated with therapeutic intent. Among the remaining 53 patients, some received 2 weeks of pre-emptive treatment after a single positive QL-PCR regardless of the viral load (group A). The treatment was initiated in the others after confirming the viral load using quantitative PCR (QT-PCR) (group B). The CMV disease rates in groups A and B were compared. Results: The 21 (39.6%) group A patients received treatment after the initial positive QL-PCR. In the 32 (60.4%) group B patients, preemptive treatment was delayed until the viral load was confirmed. In group B, the median delay before confirming the viral load was 9 days, and 20 patients (62.5%) were treated with ganciclovir, whereas 12 patients (37.5%) were reported as negative on QT-PCR and were not given ganciclovir. CMV disease developed in 6 patients (28.6%) in group A and 4 patients (20%) in group B. No CMV disease developed in patients who were reported as CMV negative on QT-PCR. The rate of CMV disease in the two groups did not differ statistically (p=0.719). Conclusions: The incidence of CMV viremia after transplantation was 58.7%. The median delay until treatment to confirm the viral load was 9 days. Nevertheless, the CMV disease rates were similar. No CMV disease developed in patients who were QL-PCR positive but QT-PCR negative. Delaying pre-emptive therapy until after confirming the viral load in QL-PCR-positive patients does not affect the CMV disease rate and may reduce unnecessary use and drug-related toxicity.
￭ S-498 ￭
Clinical efficacy of a bortezomib, cyclophoaphamide and dexamethasone in patients with relapsed or refractory multiple myeloma: preliminary result
Departments of Internal Medicine, Hematology-Oncology, Chonnam National University Medical School
*Jae-Sook Ahn, Soo-Young Bae, Yeo-Kyeoung Kim, Deok-Hwan Yang, Hyeoung-Joon Kim, Je-Jung Lee
Backgrounds & Aims: Multiple myeloma (MM) is not curable disease despite treatment with high dose chemotherapy with hematpoietic stem cell transplantation. Salvage combination chemotherapy such as bortezomib, cyclophosphamide, thalidomide and dexamethasone is effective treatment in relapsed or refractory MM. But, toxicity interrupt the consecutive treatment especially, combined bortezomib with thalidomide.
So, we analyzed the efficacies and toxicities of bortezomib, cylclophosphamide and dexamethasone (Vel-CD) combination in patients with relapsed or refractory MM. Methods: Thirty patients received at least two cycles of treatment with bortezomib 1.3 mg/m2 IV on days 1, 4, 8, and 11; cyclophosphamide 150 mg/m2 orally on days 1-4; and dexamethasone 20 mg/m2 IV on days 1, 4, 8, and 11. Results: The median time from diagnosis was 19.3 months (range 2-250 months). Median number of previous line of treatment was 2 (range 1-6).The median number of treatment cycles was 6 (range, 2-12), the number of cycles delivered was 184. Twenty one (70%) and twelve (40%) patients received at least four or eight cycles of chemotherapy, respectively. Of the 30 patients, 22 (73.3%) achieved ≥PR after the two cycles of chemotherapy, for the 21 patients who completed four cycles of therapy, the overall response rate (≥PR) was 90.5% including 47.6% CR, 42.9% PR. In the best response for the 30 patients, 26 (86.7%) patients achieved a response, including 18 (60%) CR, 2 (6.7%) VGPR and 6 (20%) PR. With a median follow up of 7.5 months, estimated OS at 2 years was 86.7±6.2%, the median PFS was 12.4 months (95% CI:
9.4-16.9). Of the 184 evaluable cycles delivered, grade 3-4 hematologic toxicity including thrombocytopenia (15.8%), neutropenia (12%), and anemia (3.8%) were observed. Treatment induced peripheral sensory neuropathy and constipation was grade 2 in 7.6% and 3.8% of the delivered cycles, respectively. Of the 30 patients, five (16.7%) develpded pneumonic infiltration, one patient died of pneumonia. Conclusion:
Vel-CD combination in patients with relapsed or refractory MM is effective salvage chemotherapy with tolerable toxicity.
