The Comparison of Melphalan Administration on Day 3 with Administration on Day 1 on Neutrophil and Platelet Engraftment in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation

Objective: High dose chemotherapy followed by ASCT is the most important step of MM treatment. Melphalan, an alkylating agent, is the most preferable drug for conditioning regimens and dosage and timing is important with regards to side effects or engraftment timing. Engraftment time is determinative on infections and hospitalization duration.

Methods: We compared the neutrophil and thrombocyte engraftments retrospectively in patients with multiple myeloma who received melphalan 200 mg/m2 single dose on day -3 and day -1 as conditioning regimen. There were 29 patient receiving melphalan on day -1 and 42 patient on day -3.

Results: The mean neutrophil engraftment times for day -1 group and day -3 group were 12,8 ±2.4 days and 10,4±1.3 days, respectively (p < 0,001). The mean thrombocyte engraftment times for day -1 group and day -3 group were 13,48 ±3,7 days and 12,7±3,3 days, respectively (p :0,36). In day -3 group, there was no failure neither in neutrophil nor in thrombocyte engraftment but 1 patient could just get thrombocyte engraftment on day 33. In day -1 group, 2 patients could not get engraftment failure.

Conclusion: Administration of melphalan on day -3 is better than on day -1 in terms of neutrophil engraftment and hence in terms of hospitalisation duration.