title: Allogeneic transplantation in multiple myeloma.
abstract: Allogeneic hematopoietic stem cell transplantation in multiple myeloma has been performed since the 1980th, but is still a controversial treatment modality. The aim is to cure the disease and the rational is to eradicate myeloma cells by the dual effect of high dose myeloablative treatment, and the immune reaction against the myeloma cells by the graft (graft versus myeloma =GVM). At the same time the patient is saved from myeloablation by the normal allogeneic donor stem cells. Although outcome has improved with time the transplant related mortality using myeloablation is still high. Therefore reduced intensity non-myelablative conditioning (RIC) has increasingly substituted myeloablation and results have improved. Out of five published or ongoing prospective clinical trials using tandem autologous (ASCT) - RIC-allogeneic transplantation (RIC-allo) compared to tandem or single ASCT the tandem ASCT-RIC-Allo approach was superior. Attempts to improve outcome by adding new drugs ( thalidomide, bortezomib or lenalidomide ) or alternative cell therapies like donor T-cell infusions or NK cell treatment may improve results.
authors.affiliation: Department of Medicine, Karolinska Institutet and Karolinska University Hospital Huddinge, Stockholm, Sweden. gosta.gahrton@ki.se
authors.forename: Gösta
authors.initials: G
authors.lastname: Gahrton
mesh_terms: D000818:Animals; D001897:Boronic Acids / Q000627:therapeutic use; D000069286:Bortezomib; D006086:Graft vs Host Disease / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000077269:Lenalidomide; D051379:Mice; D009101:Multiple Myeloma / Q000188:drug therapy / Q000601:surgery*; D019653:Myeloablative Agonists / Q000627:therapeutic use; D011719:Pyrazines / Q000627:therapeutic use; D013792:Thalidomide / Q000031:analogs & derivatives / Q000627:therapeutic use; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D001897:Boronic Acids; D007166:Immunosuppressive Agents; D019653:Myeloablative Agonists; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D000077269:Lenalidomide