Transplantation for multiple myeloma: who, when, how often?

doi:10.1182/blood-2003-01-0073

Cited by 74 publications

(19 citation statements)

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“…ASCT improves median OS in multiple myeloma by approximately 12 months [85][86][87][88]. However, three randomized trials show that OS is similar whether ASCT is done early (immediately following four cycles of induction therapy) or delayed (at the time of relapse as salvage therapy) [89][90][91].…”

Section: Role Of Hematopoietic Stem Cell Transplantationmentioning

confidence: 99%

Multiple myeloma: 2013 update on diagnosis, risk‐stratification, and management

2013

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Disease overviewMultiple myeloma accounts for approximately 10% of hematologic malignancies.DiagnosisThe diagnosis requires 10% or more clonal plasma cells on bone marrow examination or a biopsy proven plasmacytoma plus evidence of associated end‐organ damage. In addition, the presence of 60% or more clonal plasma cells in the marrow is also considered as myeloma regardless of the presence or absence of end‐organ damage.Risk stratificationIn the absence of concurrent trisomies, patients with 17p deletion, t(14;16), and t(14;20) are considered to have high‐risk myeloma. Patients with t(4;14) translocation are considered intermediate‐risk. All others are considered as standard‐risk.Risk‐adapted initial therapyStandard‐risk patients can be treated with lenalidomide plus low‐dose dexamethasone (Rd), or a bortezomib‐containing triplet such as bortezomib, cyclophosphamide, dexamethasone (VCD). Intermediate‐risk and high‐risk patients require a bortezomib‐based triplet regimen. In eligible patients, initial therapy is given for approximately 4 months followed by autologous stem cell transplantation (ASCT). Standard‐risk patients can opt for delayed ASCT if stem cells can be cryopreserved. In patients are not candidates for transplant, initial therapy is given for approximately 12–18 months.Maintenance therapyAfter initial therapy, lenalidomide maintenance is considered for standard‐risk patients who are not in very good partial response or better, while maintenance with a bortezomib‐based regimen should be considered in pateints with intermediate or high‐risk myeloma.Management of refractory diseasePatients with indolent relapse can be treated first with two‐drug or three‐drug combinations. Patients with more aggressive relapse often require therapy with a combination of multiple active agents. Am. J. Hematol. 88:225–235, 2013. © 2013 Wiley Periodicals, Inc.

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Section: Role Of Hematopoietic Stem Cell Transplantationmentioning

confidence: 99%

Multiple myeloma: 2013 update on diagnosis, risk‐stratification, and management

2013

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“…[1][2][3][4][5][6] The use of autologous PBSC has reduced the incidence of transplant-related mortality in MM by shortening the period of neutropenia and lowering the number of severe infections. 7,8 The most common regimen for mobilizing PBSC, high-dose cyclophosphamide (4-7 g/m 2 ) followed by granulocyte colony-stimulating factor (G-CSF), is burdened by considerable hematological and extra-hematological toxicity, does not have significant antitumor activity, [8][9][10][11] and between 20 and 30% of patients fail to mobilize adequate numbers of hematopoietic stem cells into the peripheral circulation (the so-called poor mobilizers).…”

Section: Pheral Stem Cellsmentioning

confidence: 99%

Efficacy, toxicity and feasibility of a shorter schedule of DCEP regimen for stem cell mobilization in multiple myeloma

Corso

Mangiacavalli

Nosari

et al. 2005

Bone Marrow Transplant

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Summary:From 2000 to 2004, 152 patients with multiple myeloma aged p65 years, enrolled in high-dose programs, were treated with two schedules of DCEP (dexamethasone, cyclophosphamide, etoposide, and cisplatin): 106 patients (group I) were mobilized with the infusional version of DCEP (infusional-DCEP), and 46 patients (group II) with a shorter version (DCEP-short). The median number of CD34 þ cells collected was similar in the two groups as was the percentage of patients yielding X4 Â 10 6 cells/kg. The proportion of patients in whom mobilization failed was similar in the two groups. The incidence of WHO grade III neutropenia was higher in group II, although the difference was not statistically significant; the percentage of patients requiring hospitalization for severe infections was similar in the two groups. The incidence of WHO grade IV thrombocytopenia did not differ between the two groups. The response rate was 72% in group I and 80% in group II with similar percentages of patients achieving good responses. DCEP-short is a good mobilizing regimen, sharing the same characteristics as infusional-DCEP: high mobilizing efficacy, low toxicity and good antitumor activity. This new schedule of DCEP does, however, allow complete outpatient management and so could be advantageously included in any high-dose therapy program. High-dose melphalan with peripheral blood stem cell (PBSC) rescue represents the standard therapy for patients with newly diagnosed multiple myeloma (MM). 1-6 The use of autologous PBSC has reduced the incidence of transplant-related mortality in MM by shortening the period of neutropenia and lowering the number of severe infections. 7,8 The most common regimen for mobilizing PBSC, high-dose cyclophosphamide (4-7 g/m 2 ) followed by granulocyte colony-stimulating factor (G-CSF), is burdened by considerable hematological and extra-hematological toxicity, does not have significant antitumor activity, [8][9][10][11] and between 20 and 30% of patients fail to mobilize adequate numbers of hematopoietic stem cells into the peripheral circulation (the so-called poor mobilizers). Therefore, more intensive regimens with stronger anticancer effects and greater mobilizing capacity, such as DICEP and DHAP, have been investigated; the results have been positive, but the feasibility of using these regimens is often limited by their toxicity. [12][13][14][15] We previously demonstrated that, compared to highdose cyclophosphamide, an infusional regimen of DCEP (dexamethasone, and continuous infusions of cyclophosphamide, etoposide, and cisplatin) is more effective at mobilizing PBSC, has better antitumor activity, is associated with less toxicity and reduces the need for hospitalization. [16][17][18][19][20] In January 2003, we designed a new DCEP schedule (DCEP-short) that is administered over a shorter period in order to allow complete outpatient management during the mobilization phase.In this study we retrospectively compare the efficacy of PBSC mobilization and the toxicity of the two mobilizing regimens: ...

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“…[11][12] Whether autologous SCT is beneficial for the majority of patients or the overall benefit comes from certain subsets of patients is still an unresolved issue. 4,13 In this regard, it has been claimed that patients with primary resistant disease are the most likely to benefit from early autologous SCT. 14,15 However, there is a paucity of published evidence to support this claim.…”

Section: Introductionmentioning

confidence: 99%