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“No” for the allogeneic stem cell transplantation in young patients diagnosed with multiple myeloma
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Abstract
Autologous stem cell transplantation (ASCT) is considered the standard of care in younger patients diagnosed with multiple myeloma (MM). However, despite an increase in the number of sustained responses, MM remains an incurable disease. Allogeneic stem cell transplantation (alloSCT) may have a curative potential resulting from induction of graft-versus-myeloma effect, but several factors limit its implementation in routine clinical practice. Myeloablative conditioning is associated with high (> 30%) treatment-related mortality (TRM), primarily due to graft-versus-host disease and infections, while the use of reduced-intensity conditioning increases the risk of relapse and disease progression, and also results in an unacceptably high TRM (21–23%). Auto/allotransplantation is not superior to tandem ASCT in terms of progression-free survival and overall survival, even in high-risk MM patients. The majority of younger patients may achieve sustained remissions after novel agents and ASCT, and nowadays alloSCT should be considered mainly in the context of clinical trials.
Abstract
Autologous stem cell transplantation (ASCT) is considered the standard of care in younger patients diagnosed with multiple myeloma (MM). However, despite an increase in the number of sustained responses, MM remains an incurable disease. Allogeneic stem cell transplantation (alloSCT) may have a curative potential resulting from induction of graft-versus-myeloma effect, but several factors limit its implementation in routine clinical practice. Myeloablative conditioning is associated with high (> 30%) treatment-related mortality (TRM), primarily due to graft-versus-host disease and infections, while the use of reduced-intensity conditioning increases the risk of relapse and disease progression, and also results in an unacceptably high TRM (21–23%). Auto/allotransplantation is not superior to tandem ASCT in terms of progression-free survival and overall survival, even in high-risk MM patients. The majority of younger patients may achieve sustained remissions after novel agents and ASCT, and nowadays alloSCT should be considered mainly in the context of clinical trials.
Keywords
multiple myeloma, allotransplantation, allogeneic transplantation, treatment-related mortality, graftversus- host disease
About this articleTitle
“No” for the allogeneic stem cell transplantation in young patients diagnosed with multiple myeloma
Journal
Nowotwory. Journal of Oncology
Issue
Article type
Other materials agreed with the Editors
Pages
205-211
Published online
2019-01-16
Page views
301
Article views/downloads
603
DOI
10.5603/NJO.2018.0033
Bibliographic record
Nowotwory. Journal of Oncology 2018;68(4):205-211.
Keywords
multiple myeloma
allotransplantation
allogeneic transplantation
treatment-related mortality
graftversus- host disease
Authors
Artur Jurczyszyn
Anna Suska