Reduced-dose carmustine (300 mg/m2) and melphalan as a conditioning regimen in multiple myeloma patients with CNS involvement: A case series

Single-agent melphalan remains the gold standard for conditioning chemotherapy prior to autologous stem cell transplantation (ASCT) in the multiple myeloma (MM) setting. Melphalan's distribution in the central nervous system (CNS) is limited which raises the question if single-agent melphalan is the ideal conditioning regimen for MM patients with extramedullary involvement in the CNS. Here we present two patients with MM and CNS involvement at baseline who safely received reduced-dose carmustine (300 mg/m²) and melphalan for conditioning chemotherapy prior to ASCT. While this combination has been studied previously, no studies to our knowledge added carmustine to the preparative regimen explicitly for additive CNS penetration in patients with CNS involvement.