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Cure of multiple myeloma -- more hype, less reality. Bone Marrow Transplant 2006 Jan;37(1):1-18 PMID: 16258534

Pubmed ID

16258534

Abstract

Randomized studies have firmly established the role of autologous transplant as initial therapy in multiple myeloma (MM). Indeed, MM has emerged as the commonest indication for autologous SCT in North America. The conceptual basis for high-dose therapy is the goal of complete remission (CR) through steep reduction in tumor burden affected by single and tandem transplants. Careful analysis of the data challenges the notion of CR as a surrogate to success. Intrinsically aggressive MM, defined by known unfavorable biologic risk factors, overrides the benefit of CR. In contrast, subgroups of patients with favorable biological risk factors may achieve prolonged survival, often without ever achieving CR. Unfortunately, even with tandem transplants, there is no plateau in survival curves. To this end, sequential autologous followed by nonmyeloablative allotransplants are a novel attempt at 'curing' myeloma, but the results thus far have failed to show a definite plateau in survival. Given the improvements in supportive care and concomitant reduction in transplant-related mortality, conventional myeloablative allogeneic transplants need to be re-examined as an option in high-risk aggressive myeloma. At the same time, novel antimyeloma therapies, newer risk stratification and staging tools are transforming the treatment algorithm. We examine the changing role of transplantation in myeloma in the context of novel drug therapy, biologic risk stratification and improving supportive care while arguing that the current 'one size fits all' transplant approaches are far from a cure.

Author List

Hari P, Pasquini MC, Vesole DH

Authors

Parameswaran Hari MD Chief, Professor in the Medicine department at Medical College of Wisconsin
Marcelo C. Pasquini MD, MS Associate Professor in the Medicine department at Medical College of Wisconsin




Scopus

2-s2.0-31344453763   22 Citations

MESH terms used to index this publication - Major topics in bold

Disease-Free Survival
Humans
Multiple Myeloma
Remission Induction
Risk Factors
Stem Cell Transplantation
Survival Rate
Transplantation, Autologous
Tumor Burden
jenkins-FCD Prod-296 4db9d02597e0a2e889e230f853b641c12f1c3ee3