Complications:
Two patients experienced temporary high fever and severe inflammatory response syndrome (SIRS) after the melphalan / cytarabine administration prior to the allogeneic HSCT. No intensive care treatment was required. In one case a temporary elevation of liver enzymes GOT and GPT was registered (> eight fold the upper norm limit) after the salvage regimen melphalan / cytarabine. One patient developed a temporary severe disorder of blood coagulation requiring the administration of blood products and coagulation factors.
Survival: The median overall survival was 8 months (range 2 months – 49 months). The one year survival rate was 50% (Fig. 1). Four patients (50%) died within one year, all deaths were disease-related. The three year survival rate was 29% (Fig. 1). Five patients (71%) died within three years, four deaths were disease-related, one death was therapy-related (bacterial sepsis with subsequent renal and pulmonary failure) and occurred ten months after HSCT. One patient died 3,6 years after Melphalan, the death was therapy-related (severe systemic Aspergillosis). Five patients (63%) achieved a remission and were able to receive an allogeneic stem cell transplantation afterwards. Three patients (38%) did not respond to the melphalan / cytarabine regimen and were considered as treatment failure. One patient (13%) received palliative care only. Two patients (25%) received another salvage regimen (consisting in one case of three cycles of clofarabine, cyclophosphamide and etoposide and in one case of one cycle of clofarabine, cyclophosphamide, etoposide and cytarabine). Both patients could be transplanted afterwards. The median event free survival was 8 months (range 2 months – 42 months).