Allogeneic Stem Cell Transplantation in Patients with High-Risk Multiple Myeloma: Utopia or Continuous Challenge in Aiming for Cure?

Kaloyannidis, Panayotis; Apostolidis, John

doi:10.1007/s11864-021-00864-x

Cited by 4 publications

(3 citation statements)

References 68 publications

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“…Despite the current advances in the treatment of MM including the introduction of several classes of novel agents, MM remains incurable and eventually most patients develop progressive disease [142][143][144][145]. Currently, allogeneic HSCT represents the only potentially curative therapy for patients with MM [146][147][148][149]. In MM patients, allogeneic HSCT exerts its therapeutic efficacy mainly through its graft versus myeloma (GVM) [143,144,146].…”

Section: Allogeneic Hsct In MMmentioning

confidence: 99%

“…In MM patients, allogeneic HSCT exerts its therapeutic efficacy mainly through its graft versus myeloma (GVM) [143,144,146]. It is reasonable to consider allogeneic HSCT as the treatment strategy for younger patients with MM having HR disease as several studies have shown that allogeneic HSCT can potentially overcome the adverse prognosis of HR cytogenetics [143,[146][147][148]. In MM patients, the use of myeloablative conditioning (MAC) in allogeneic HSCT is associated with high treatment-related mortality (TRM) mainly due to the regimen-related toxicities and GVHD which are translated into considerable transplant-related morbidity and mortality while the use of reduced intensity conditioning (RIC) in allogeneic HSCT is associated with high relapse rates [144,145,[147][148][149].…”

Section: Allogeneic Hsct In MMmentioning

confidence: 99%

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An Update on Hematopoietic Stem Cell Transplantation in Patients with Multiple Myeloma

Al-Anazi¹,

Alshaibani²,

Kalogianidis³

2023

Recent Updates on Multiple Myeloma

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Over the past two decades, treatment of multiple myeloma (MM) has advanced dramatically. However, despite the introduction of several lines of novel therapeutics, autologous hematopoietic stem cell transplantation (HSCT) followed by maintenance therapy is the current standard of care in transplant eligible patients. Autologous HSCT can be performed with or without cryopreservation with equivalent short-term and long-term outcomes. In patients with MM, performance of autologous HSCT at outpatient setting is safe, feasible and has a number of advantages such as saving hospital beds and reducing treatment costs. Autologous HSCT can be safely performed in patients with MM having renal dysfunction or failure although particular attention should be made to the timing of administering medications and stem cells with respect to hemodialysis and dose reduction of specific medications according to creatinine clearance. Tandem autologous HSCT is of value in younger patients with adverse cytogenetics and extramedullary disease. Allogeneic HSCT is the only potentially curative therapeutic modality in MM, but it can only be performed in a small fraction of highly selected patients due to the relatively high treatment-related morbidity and mortality. Despite its valuable role in the treatment of MM, autologous HSCT has its own short-term as well as long-term complications.

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Section: Allogeneic Hsct In MMmentioning

confidence: 99%

Section: Allogeneic Hsct In MMmentioning

confidence: 99%

An Update on Hematopoietic Stem Cell Transplantation in Patients with Multiple Myeloma

Al-Anazi¹,

Alshaibani²,

Kalogianidis³

2023

Recent Updates on Multiple Myeloma

View full text Add to dashboard Cite

show abstract

“…• The doses of Cyclophosphamide in stem cell mobilization prior to ASCT are Low dose (LD-Cy) from 1 to 1,5 g/m 2 intravenously, Intermediate dose (MD-Cy) from 3 to 4 g/m 2 intravenously, High dose (HD-Cy) from 5 to 7 g/m 2 intravenously: the first option is the most preferred in the practical use and clinical trial to avoid long-term cytopenias and extra-hematological toxicities [145][146][147];…”

Section: Medical Therapymentioning

confidence: 99%

Recent Updates on Multiple Myeloma

2023

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extra-hematological toxicity, and the brief period of neutropenia [24, 25]. Outpatient HSCT has certain inclusion criteria and exclusion criteria as well as several advantages that include: significant reduction in costs; saving hospital beds; lower rate of infections; and lower morbidity and treatment-related mortality [24,[26][27][28].In patients with MM, maintenance therapy after autologous HSCT has been shown to deepen and prolong responses and increase OS and progression-free survival (PFS) [29]. Lenalidomide maintenance given after autologous HSCT till disease progression is the standard of care in patients with SR MM while bortezomib maintenance therapy after autologous HSCT is preferable in MM patients having: HR cytogenetics, renal insufficiency, inability to tolerate lenalidomide, and previous history of another cancer [30][31][32]. Continuous therapy has been shown to significantly improve OS and PFS [33, 34]. Continuous therapy till disease progression has become a key strategy in the treatment of patients with MM as it has been shown to improve duration of remission and it represents the standard approach for patients with MM both at diagnosis and at relapse [35, 36].Unfortunately, nearly all MM patients ultimately relapse, even those who experience a complete response (CR) to initial therapy [19]. Management of the relapsed disease remains a critical aspect of MM care and an important area of ongoing research [19]. New treatment strategies and therapeutic modalities are needed to treat MM in relapse, particularly in case of triple-refractory disease [1]. Treatment of relapsed MM should depend on: the number of relapses encountered; the previous anti-myeloma treatment; the presence of de novo or acquired drug resistance; aggressiveness of disease relapse particularly in case of extramedullary disease, plasma cell leukemia, or clonal evolution [3, 37].Minimal residual disease (MRD) is an important factor that can independently predict the prognosis of MM during treatment as undetectable MRD has been shown to improve PFS and OS regardless: disease status, prior transplant, or cytogenetic risk [38]. Flow cytometry has become a valuable tool to monitor MRD and evaluate the depth of CR. However, next-generation flow cytometry is more sensitive than the standard flow cytometry in detecting MRD in patients with MM [39]. Finally, the development of novel targeting therapies with different mechanisms of action is needed to achieve deep and durable responses in an attempt to cure MM while identification of tumor intrinsic and extrinsic resistance mechanisms may direct the design of combinations of novel drugs that prevent or overcome drug resistance so as to improve patient survival [40, 41].

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Chimerism analysis for clinicians: a review of the literature and worldwide practices

Blouin

Askar

2022

Bone Marrow Transplant

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Allogeneic Stem Cell Transplantation in Patients with High-Risk Multiple Myeloma: Utopia or Continuous Challenge in Aiming for Cure?

Cited by 4 publications

References 68 publications

An Update on Hematopoietic Stem Cell Transplantation in Patients with Multiple Myeloma

An Update on Hematopoietic Stem Cell Transplantation in Patients with Multiple Myeloma

Recent Updates on Multiple Myeloma

Chimerism analysis for clinicians: a review of the literature and worldwide practices

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