{"doi":"10.3389/fimmu.2024.1310752","title":"Impact of melphalan day -1 vs day -2 on outcomes after autologous stem cell transplant for multiple myeloma","abstract":"Background Melphalan is the most common conditioning regimen used prior to autologous stem cell transplant (ASCT); however, there are varying data on optimal melphalan timing prior to transplant for best safety and efficacy. Historically, ASCT conditioning consisted of melphalan 200 mg/m 2 on day 2 (D-2) (48 h prior to ASCT), but many institutions have since adopted a melphalan protocol with administration on day 1 (D-1) (24 h prior to SCT) or split dosing over the 2 days. The optimal timing of melphalan has yet to be determined. Methods In this single-center retrospective study, we analyzed transplant outcomes for patients between March 2011 and September 2020 admitted for high-dose, single-agent melphalan 200 mg/m 2 on D-1 vs. D-2. The primary outcomes were time to neutrophil and platelet engraftment. Secondary outcomes include incidence of hospital readmission within 30 days, 2-year progression-free survival, and 2-year overall survival. Results A total of 366 patients were studied (D-2 n = 269 and D-1 n = 97). The incidence of high-risk cytogenetics was similar between the two groups (37% vs. 40%). Median days to absolute neutrophil count engraftment was similar at 11 days in the D-2 and D-1 cohort (n = 269, range 0–14, IQR 11–11 vs. n = 97, range 0–14, IQR 11–12). Median days to platelet engraftment >20,000/mcL was 18 days for D-2 melphalan (range: 0–28, IQR 17–20) versus 19 days for D-1 melphalan (range: 0–32, IQR 17–21). Overall survival at 2 years post-transplant was similar in both cohorts (94%; p = 0.76), and PFS was 70% in D-2 compared with 78% in D-1 (p = 0.15). In a multivariable model including age and performance status, hospital readmission within 30 days of transplant was higher in the D-1 cohort (odds ratio 1.9; p = 0.01). Conclusion This study demonstrates similar neutrophil and platelet engraftment in D-1 and D-2 melphalan cohorts with similar 2-year PFS and OS. Either D-2 or D-1 melphalan dosing schedule is safe and effective.","journal":"Frontiers in Immunology","year":2024,"id":473116,"datarank":0.10397207708399181,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"self_citation_contribution":0.10397207708399181,"citation_network_contribution":0.0,"self_endowment_contribution":0.10397207708399181,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9522,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":259421,"name":"Ryan Shanley","orcid":"0000-0003-2398-5466","position":1,"is_corresponding":false},{"id":1281934,"name":"Faridullah Rashid","orcid":null,"position":2,"is_corresponding":false},{"id":1309204,"name":"Jenna Langer","orcid":null,"position":3,"is_corresponding":false},{"id":293777,"name":"Michelle Dolan","orcid":null,"position":4,"is_corresponding":false},{"id":1309205,"name":"Sarah Tu","orcid":null,"position":5,"is_corresponding":false},{"id":414022,"name":"Najla El Jurdi","orcid":"0000-0002-9268-9655","position":6,"is_corresponding":false},{"id":414023,"name":"John Rogosheske","orcid":"0000-0003-1717-6427","position":7,"is_corresponding":false},{"id":1308912,"name":"Kirollos S. Hanna","orcid":"0000-0002-3467-9336","position":8,"is_corresponding":false},{"id":414024,"name":"Todd E. DeFor","orcid":"0000-0003-4667-0176","position":9,"is_corresponding":false},{"id":364549,"name":"Murali Janakiram","orcid":"0000-0001-9323-8007","position":10,"is_corresponding":false},{"id":122976,"name":"Daniel J. Weisdorf","orcid":"0000-0001-8078-8579","position":11,"is_corresponding":false},{"id":323242,"name":"Aimee Merino","orcid":"0000-0003-4433-0127","position":0,"is_corresponding":true}],"reference_count":18,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T02:06:01.000126Z","pmid":"38504993","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}