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Hematopoietic stem cell transplants for multiple myeloma

G Tricot1, S Jagannath, D H Vesole

  • 1Division of Hematology/Oncology, University of Arkansas for Medical Sciences, Little Rock, USA.

Leukemia & Lymphoma
|June 1, 1996
PubMed
Summary

High-dose melphalan with stem cell support, known as autotransplantation, offers improved complete remission rates and survival for multiple myeloma patients compared to standard chemotherapy. Further research is needed to overcome relapses and achieve cures.

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Area of Science:

  • Hematology
  • Oncology
  • Stem Cell Transplantation

Background:

  • Standard chemotherapy for multiple myeloma has shown limited success in extending overall survival and achieving complete remission (CR) over the past three decades.
  • Conventional therapies have a notable early mortality rate (2-10%) and offer rare CRs.
  • Increased melphalan doses (100-140 mg/m2) improved CR rates (30-45%) and survival by approximately one year, but led to unacceptably high treatment-related morbidity and mortality due to prolonged cytopenia.

Purpose of the Study:

  • To evaluate the efficacy and safety of intensified chemotherapy regimens, including high-dose melphalan and total body irradiation, supported by stem cell transplantation for multiple myeloma.
  • To compare the outcomes of autotransplantation with conventional chemotherapy in newly diagnosed and refractory multiple myeloma patients.
  • To determine the potential of autotransplantation as a curative approach and identify areas for future improvement.

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Main Methods:

  • Dose escalation of melphalan to 200 mg/m2 or addition of total body irradiation, combined with stem cell support (autologous transplants, particularly peripheral blood stem cells with hematopoietic growth factors).
  • Patient population included newly diagnosed and refractory multiple myeloma cases, with a focus on safety up to age 70.
  • Assessment of complete remission rates, transplant-related mortality, and overall survival.

Main Results:

  • Autologous transplantation, especially with peripheral blood stem cells and growth factors, is now safely performed up to age 70 with low transplant-related mortality (2-10%).
  • Complete remission rates of approximately 50% in previously untreated patients and 10-20% in refractory cases were achieved.
  • Overall survival appears superior for patients treated with autotransplants compared to conventional chemotherapy.

Conclusions:

  • Autotransplantation should be considered a viable treatment option for multiple myeloma patients, particularly those under 65.
  • While autotransplantation improves outcomes, it is not yet a curative approach for a significant proportion of patients, with most ultimately relapsing.
  • Future advancements should focus on enhancing graft quality (tumor-free grafts) and implementing post-transplantation strategies to eradicate minimal residual disease.