Bone marrow transplantation for multiple myeloma: where we are today.
Multiple myeloma is incurable with standard chemotherapy. Autologous transplantation appears to offer a modest survival advantage over standard dose chemotherapy, but most patients subsequently relapse. Through the induction of graft-versus-tumor activity, allogeneic bone marrow transplantation can lead to long-term disease-free survival, and cure in some patients with myeloma. Transplant-related mortality after allogeneic bone marrow transplantation is high. Many patients are ineligible for this approach because of advanced age, comorbid illnesses, and extensive previous chemotherapy. Ongoing investigations endeavor to reduce regimen-related mortality through nonmyeloablative preparative regimens while maintaining immunologic antitumor activity through donor lymphocytes, which have significant graft-versus-myeloma activity. Early reports demonstrate lower rates of transplant related mortality; however, graft-versus-host disease rates are high and can preclude the administration of graded donor lymphocyte infusions, which may optimize the therapeutic index of graft-versus-host reactivity.
Huff
Carol Ann
CA
Johns Hopkins University, Department of Oncology, Baltimore, Maryland 21231, USA. Huffca@jhmi.edu
Jones
Richard J
RJ
D016026:Bone Marrow Transplantation; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D006086:Graft vs Host Disease / Q000517:prevention & control; D006801:Humans; D009101:Multiple Myeloma / Q000628:therapy*; D012074:Remission Induction; D014184:Transplantation, Homologous