36 / safety and toxicity of oral melphalan use in bone marrow transplantation in patients with multiple myeloma, in a setting without venous medication supply.

CONTEXT: Autologous Peripheral Stem Cell Transplantation (PSCT) is a standard treatment for patients with Multiple Myeloma (MM), which, although not curative, significantly increases disease-free progression and overall survival.Melphalanis the drug of choice. However, in Brazil, there was a shortage of this drug in itsintravenouslypresentation in the second half of 2016, making it impossible to perform the treatment. In search of alternatives for this, the same drug was used in its oral presentation for this purpose. There are few studies in the literature with this oral drug use for this purpose.OBJECTIVE:The aim is a describe thepatients whowas submitted tooral melphalan.DESIGN: A retrospective study, based on medical records, which analyzed 20 consecutive patients who received the drug between June 2016 and January 2017.RESULTS: Of the 20 patients selected, 12 (60%) were male , with the median ageof60 years (31-68). The main induction regimen was VCD (Velcade, Cyclophosphamide and Dexamethasone) in 85%, followed by VTD (Velcade, Thalidomide and Dexamethasone) by 15%. 14 patients (70%) obtained at least partial response to PSCT. 85% (17) patients were mobilized with GCSF and 15% (3) with chemotherapy+ GCSF. The median number of cells infused was 7.135 x 10 (6) cel / mm 3 / kg (3.62 - 11.9). Dose used had median: 200mg / m2 (140-200 mg / m2), neutrophil grafting occurred in median 12 days (10 - 16), total transfusional need (1; 0-3), febrile neutropenia occurred in 6 patients, mucositis in 3 episodes (2 patients grade I and 1 patient with grade II) and time of hospitalization 15 days (13-21). There were no deaths during the study.CONCLUSION: The current study shows the factuality for oral melphalan use. Studies comparing oral versus intravenous melphalan regarding efficacy are necessary.