Stem-cell transplantation in multiple myeloma.
In patient with newly diagnosed multiple myeloma (MM), randomized studies have shown that autologous stem-cell transplantation (ASCT) is superior to conventional chemotherapy, and ASCT is now standard care, at least for younger patients. The best conditioning regimen is melphalan 200 mg/m2, and the best stem-cell source is unselected peripheral progenitor cells. Recent results of the IFM94 trial show that double ASCT is superior to single ASCT, at least in patients who do not achieve a 90% response after one transplant. By combining biologic markers (beta2-microglobulin, albumin) and genetic markers (hypodiploidy, chromosome 13 deletion) it is possible to accurately predict prognosis after ASCT. The results of allogeneic SCT remain disappointing due to a high transplant mortality. Strategies combining ASCT and reduced-intensity allogeneic SCT are currently being studied.
Harousseau
Jean-Luc
JL
Department of Hematology, Hotel Dieu, Nantes, France. jlharousseau@sante.univ-nantes.fr
Moreau
Philippe
P
Attal
Michel
M
Facon
Thierry
T
Avet-Loiseau
Hervé
H
D015415:Biomarkers / Q000032:analysis; D005819:Genetic Markers; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D009101:Multiple Myeloma / Q000175:diagnosis / Q000628:therapy*; D011379:Prognosis; D019172:Transplantation Conditioning / Q000379:methods
D015415:Biomarkers; D005819:Genetic Markers