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Progress in allogeneic transplantation for multiple myeloma
Author(s) -
Gahrton Gösta
Publication year - 2010
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/j.1600-0609.2010.01495.x
Subject(s) - medicine , multiple myeloma , transplantation , pomalidomide , thalidomide , bortezomib , oncology , lenalidomide , hematopoietic stem cell transplantation , donor lymphocyte infusion , cyclophosphamide , surgery , chemotherapy
Abstract Allogeneic hematopoietic stem cell transplantation to treat multiple myeloma has been attempted since the early 1980s. The original conditioning regimen including high‐dose total body irradiation (TBI) plus cyclophosphamide was myeloablative and associated with a relatively low relapse/progression rate, but high transplant‐related mortality and no obvious improvement in progression‐free survival or overall survival. Some risk groups may benefit from this transplant modality and occasional patients may be cured, but due to the high‐transplant‐related mortality it is mainly abandoned. Reduced intensity conditioning (RIC), non‐myeloablative allogeneic transplantation reduces transplant‐related mortality significantly when compared with myeloablative conditioning, but the relapse/progression rate is somewhat higher. However although the treatment‐related mortality is higher than after autologous transplantation, the progression‐free and overall survival was better or tended to be better in three of five prospective trials comparing tandem autologous/RIC allogeneic transplantation to single or tandem autotransplantation due to lower relapse/progression rate. Adding donor lymphocyte infusions post‐transplant, new drugs like bortezomib, thalidomide, lenalidomide or pomalidomide pre‐ and/or post‐transplant, and more specific antimyeloma cell therapy like NK cells post‐transplant, may in future studies prove to improve results.