[Stem cell transplantation in multiple myeloma].

Area of Science:

• Hematology
• Oncology
• Immunology

Context:

• Multiple myeloma treatment has evolved significantly.
• High-dose chemotherapy with autologous hematopoietic stem cell transplantation (ASCT) is a key therapeutic approach.
• ASCT offers improved survival rates compared to conventional chemotherapy.

Purpose:

• To review the efficacy and challenges of ASCT in multiple myeloma.
• To discuss current and emerging strategies in hematopoietic stem cell transplantation for multiple myeloma.
• To evaluate the role of allogeneic bone marrow transplantation (allo-BMT) and novel approaches.

Summary:

• ASCT achieves high complete remission rates (approx. 40%) and extends overall survival in multiple myeloma.
• Challenges include tumor cell contamination in grafts, leading to relapse.
• New trials focus on CD34+ cell selection and double auto-transplantation to mitigate risks.
• Allogeneic bone marrow transplantation (allo-BMT) is an option for select younger patients but has high mortality and no survival advantage over ASCT.
• Nonablative stem cell transplantation with donor lymphocyte infusions (DLI) is being investigated for graft-versus-myeloma (GVM) effect.

Impact:

• ASCT has become a standard of care, significantly improving outcomes for multiple myeloma patients.
• Research into graft purification and alternative transplant modalities aims to further enhance treatment efficacy and reduce relapse rates.
• Understanding prognostic factors and optimal timing of ASCT is crucial for treatment individualization.