Allogeneic stem cell transplantation for multiple myeloma: is there a future?

Area of Science:

• Hematology
• Oncology
• Immunotherapy

Background:

• Multiple myeloma (MM) remains largely incurable, with most patients experiencing relapse despite novel therapies.
• High-risk MM patients face an aggressive disease course, necessitating advanced treatment strategies.
• Allogeneic hematopoietic cell transplantation (allo-SCT) presents a potentially curative option for MM, leveraging immune-mediated control.

Purpose of the Study:

• To review the current literature on allo-SCT for multiple myeloma.
• To discuss the evolving role of allo-SCT in managing MM, particularly high-risk disease.
• To present the authors' clinical approach to utilizing allo-SCT and other immunotherapies in MM.

Main Methods:

• Comprehensive literature review of allo-SCT and immunotherapy in multiple myeloma.
• Analysis of recent advancements in preparative regimens, maintenance strategies, and supportive care.
• Discussion of immunotherapy options at relapse, including donor lymphocyte infusions.

Main Results:

• Historically high treatment-related mortality (TRM) associated with allo-SCT has decreased due to improved protocols and supportive care.
• Recent studies indicate better survival outcomes with allo-SCT in MM.
• The allo-SCT platform facilitates post-transplant immunotherapy, enhancing disease control.

Conclusions:

• Allo-SCT is an increasingly viable and potentially curative treatment for select multiple myeloma patients, especially those with high-risk disease.
• Ongoing improvements in TRM and survival underscore the expanding role of allo-SCT.
• Integrating allo-SCT with novel immunotherapies holds promise for achieving durable remissions in MM.