Role of allogeneic stem cell transplantation in multiple myeloma

Abstract

Multiple myeloma remains incurable despite the use of high-dose therapy and autologous stem cell transplantation and the introduction of novel agents with high response rates. The use of an uncontaminated stem cell graft and the presence of a graft-versus-myeloma effect led to the use of allogeneic stem cell transplantation in myeloma, and it has been part of the therapeutic armamentarium for more than a decade. Early results were discouraging due to high transplantation-related mortality and high rates of graft-versus-host disease. More recently, better supportive care, increasing experience with this modality and its complications, use of reduced-intensity conditioning regimens, and its use earlier in the course of disease have led to improved outcomes. Patients with high-risk genetic and biochemical features do poorly with conventional therapies, and allogeneic transplantation offers the potential for long-term disease control.

Therapy for Relapsed Multiple Myeloma

“…174 Fit patients may be referred for consideration of ASCT in an attempt to improve their survival. 186–188 Although the procedure is toxic and the disease may relapse, a substantial number of patients may achieve disease control and prolongation of survival that would otherwise be unlikely. 189 …”