ArticlePublic health action2026
Multimodal melphalan delivery: improved safety and outcomes with autologous myeloma transplant in India.
Article in Public health action, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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18 authors.
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Abstract
backgroundHigh-dose melphalan-based autologous stem cell transplantation (ASCT) remains a cornerstone of treatment in multiple myeloma but causes severe gastrointestinal toxicity in up to 50% of patients due to mucosal injury.
objectiveTo mitigate this, we assessed a multimodal approach of combined oral cryotherapy, extended duration of melphalan infusion (1 h compared to bolus), and upright patient positioning during administration.
designA cohort study using hospital patient records to evaluate the safety and outcomes of this approach at a tertiary hospital in South India, from January 2017 to March 2026.
resultsAmong 47 patients undergoing ASCT, 4% had grade 3 (severe) mucositis, 15% experienced grade 3 diarrhoea, and one patient had severe vomiting. No grade 4 (life threatening) or grade 5 (fatal) gastrointestinal toxicities were observed. Total parenteral nutrition was required in 4% patients. The median duration of stay in the transplant unit was 14 days. There was no post-transplant mortality within 1 year. Relapse-free survival at 1 year was 88%, and relapse was significantly associated with high-risk cytogenetics.
conclusionMultimodal melphalan delivery is feasible, with manageable toxicity and low rates of severe adverse events, while maintaining excellent short-term outcomes. Further multicentric evaluation and wider adoption is warranted.
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