Progress in allogeneic transplantation for multiple myeloma.
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.
Gahrton
Gösta
G
Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. gosta.gahrton@ki.se
D000970:Antineoplastic Agents / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D018572:Disease-Free Survival; D006086:Graft vs Host Disease / Q000276:immunology / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007694:Killer Cells, Natural / Q000276:immunology; D017710:Lymphocyte Transfusion; D009101:Multiple Myeloma / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D013792:Thalidomide / Q000031:analogs & derivatives / Q000627:therapeutic use; D019172:Transplantation Conditioning / Q000379:methods; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014916:Whole-Body Irradiation
D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D013792:Thalidomide; D003520:Cyclophosphamide; C467566:pomalidomide