Not too little, not too much-just right! (Better ways to give high dose melphalan).

摘要: Of the 13 286 autologous haematopoietic cell transplant procedures reported in US 2010–2012 for plasma disorders, 10 557 used single agent, high-dose melphalan. Despite 30 years of clinical and pharmacokinetic (PK) experience with melphalan, its continuing central role as cytoreductive therapy large numbers patients myeloma, pharmacodynamics pharmacogenomics melphalan are still their infancy. The addition protectant agents such amifostine palifermin allows dose escalation to 280 mg/m2, but at these doses it is cardiac, rather than gut, toxicity that dose-limiting. Although combination additional alkylating feasible, TRM may not be justified when so many post-consolidation therapies available myeloma patients. Current research should optimise delivery this single-agent chemotherapy. This includes use newer formulations real-time PKs. These strategies allow a safe effective platform adding synergistic novel provide window lymphodepletion immunotherapies.