Role of autologous stem cell transplantation in multiple myeloma.
High-dose chemotherapy with autologous stem cell transplantation (ASCT) has been shown to improve survival in patients with multiple myeloma in randomized trials and is the standard of care for eligible patients. Recent randomized trials suggest a survival benefit with tandem ASCT, notably for patients failing to achieve a very good response to initial transplantation. Other randomized trials, as well as smaller phase II trials and retrospective studies, have allowed us to improve the process of ASCT in terms of the stem cell collection, conditioning regimens, and extension of the therapy to a wider patient population. The introduction of thalidomide, lenalidomide, and bortezomib have changed the paradigm for treatment of myeloma and significantly improved the outcome for these patients. The role of ASCT will clearly be redefined in the coming years with improvements in other therapies.
Kumar
Shaji
S
Division of Hematology, Mayo Clinic, First Street SW, Rochester, MN 55905, USA. kumar.shaji@mayo.edu
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001897:Boronic Acids / Q000627:therapeutic use; D000069286:Bortezomib; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D000077269:Lenalidomide; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D009101:Multiple Myeloma / Q000188:drug therapy / Q000601:surgery*; D018579:Patient Selection; D011719:Pyrazines / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016879:Salvage Therapy; D033581:Stem Cell Transplantation / Q000379:methods; D013792:Thalidomide / Q000031:analogs & derivatives / Q000627:therapeutic use; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D001897:Boronic Acids; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D000077269:Lenalidomide