[Therapy strategies for transplant candidates of multiple myeloma]

Multiple myeloma (MM) is a malignant plasma cell neoplasm that can not be cured with the conventional chemotherapy. Although new drugs, such as bortezomib, are highly effective in controlling the disease, the hematopoietic stem cell transplantation (HSCT) still should be performed, so as to increase the patients response and survival time. For over a decade, autologous HSCT has been a critical component in the treatment plan for newly diagnosed myeloma. The survival outcome with auto-HSCT seems to be highly dependent on the ability of this approach to enhance the depth of response. Maintenance therapy prolongs the responses after auto-HSCT by continuous administration of drug, such as thalidomide. However, patients invariably relapse after single auto-HSCT or double auto-HSCT. Allogeneic HSCT for myeloma has a potential for curing MM with the presence of a graft versus myeloma effect. Currently, allogeneic approaches should be considered in MM transplant procedure. Clinical data suggest that the mortality after allo-HSCT is definitely lower with the reduced-intensity regimens, but the relapse rate was higher than myeloablative regimens. Individual-adapted treatment strategy is benefited for MM transplant candidates. This article reviews the whole process of MM transplant candidates, including regimens for initial therapy, time of transplantation, choice of transplantation procedure and maintenance therapy.