Allogeneic bone marrow transplantation in multiple myeloma.
Allogeneic transplantation in multiple myeloma can induce complete remission, defined as disappearance of abnormal immunoglobulins in the blood, light chains in the urine and no apparent myeloma cells in the marrow, in about 50 percent of patients. The five-year survival is about 30 percent and important prognostic factors for survival are to be a female, to be in stage I at the time of diagnosis irrespective of the time of transplantation, to have received only one line of treatment before transplantation, to have responsive disease and a low beta 2-microglobulin. Transplant-related mortality is between 40-50 percent, and therefore overall survival is poorer than with autologous transplantation, while long-term survival is similar with both transplant modalities. Although the relapse rate of patients in complete remission is about 50 percent at 5 years, it is still lower than with autologous transplantation. Donor lymphocyte transfusion to patients with persistent abnormal immunoglobulins or relapse may induce regression or new complete remissions. Further studies aim at reducing transplant-related mortality by using peripheral blood stem cells, CD34-selected cells, more aggressive anti-bacterial, anti-fungal and anti-viral treatment and relapse rate will be counteracted by donor lymphocyte transfusions and perhaps post-transplant interferon treatment.
Gahrton
G
G
Department of Hematology, Karolinska Institute, Huddinge University Hospital, Sweden.
D016026:Bone Marrow Transplantation; D018572:Disease-Free Survival; D006801:Humans; D009101:Multiple Myeloma / Q000401:mortality / Q000628:therapy*; D012074:Remission Induction / Q000379:methods; D015996:Survival Rate; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous