The Myeloma Alphabet Soup Handbook
Biaxin as a treatment for Myeloma

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38th Annual American Society of Hematology meeting
December 5 - 9, 1997

205 Myeloma related abstracts. http://www.hematology.org/

Abstract number: 3887
Clarithromycin (Biaxin) as primary treatment for myeloma.
Durie;Villarete;Farvard;Ornopia;Urnovitz
Los Angeles and Berkeley, CA

We report the results of Clarithromycin (Biaxin) antibiotic treatment in patients with active multiple myeloma. This trial was begun based upon results in MALT lymphoma with t(11:14)(q12:q32) associated H. Pylori infection, as a result of the detection of a circulating nucleotide sequence, which contains the same Bcl-1/JH 5/6 break point region, in patients with active myeloma. A basic schedule of 500 mg B.I.D. was utilized with ongoing dosages/schedule dependent upon initial response. 30 patients are currently enrolled with the longest followup being approximately 1 year. Treatment has been well tolerated with no untoward complications. Thus far using SWOG response criteria there have been: 6 C.R.s ( 75% regression); 7 P.R.s ( 50%); 6 stable; 4 mixed and 7 too early to evaluate. Response has been documented by improvement in clinical status, hemoglobin, serum and urine M-component, beta2M, bone marrow plus followup MRI and other scans. The first patient (previously untreated), with IgAK myeloma is in full clinical remission at approx. 1 yr: IgA from 4.3 G/dl to 300 mg/dl; plasma cells from 65% to 1%; MRI to normal. Other dramatic responses have also occurred in 2 patients relapsing after stem cell transplant and 1 patient refractory to both VAD and melphalan. Thus far patients with IgA and IgG, k subtype patients have been the best responders; versus λ BJ and non secretory patients in whom efficacy has been less. High levels of circulating nucleotide have been associated with more transient response and dose escalation is currently being explored in this subgroup. One patient with Waldenstrom's is also showing evidence of lymph node reduction and reduced IgM. Nucleotide levels clear with successful treatment. However, caution is required because rebound can occur early if BIAXIN stopped before full response is achieved. Based upon the initial results a study is now planned comparing alternate weekly cycles of BIAXIN versus a continuous 8 week course with dose escalation if necessary. The initial clinical efficacy of BIAXIN is dramatic and justifies further studies, both to evaluate potential mechanisms behind its efficacy (e.g. ? target of RNA polymerase III inhibition) as well as to determine the best patients and schedule(s) for therapy.

Dr. Brian Durie can be reached at:
Cedars-Sinai Comprehensive Cancer Center
8700 Beverly Boulevard
Los Angeles, CA 90048
(213) 966-3572
Clarithromycin (Biaxinr) as primary treatment for myeloma. http://ex2.excerptamedica.com/97ash/abstracts/abs2578.html


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