Allogeneic stem cel transplantation for myeloma in first line – pro
The role allo-HCT in MM remains controversial and poorly defined. Several randomized trials have utilized bio-logical assignment of patients to prospectively comparetandem auto-HCT-allo-HCT versus tandem auto-HCT in theupfront transplantation setting. Although allo-HCT has been considered for high-risk groups, as in this case, the optimal patient population for this strategy is not known and requires further investigation. Data on late allo-HCT is scarce, with no prospective randomized trial. The 2 trials with the longest duration of follow up are also the only trials reporting superior PFS and OS among patients assigned to auto-HCT-allo-HCT. All the remaining studies, including the largest of the trials performed, found no PFS or OS dif-ference between the 2 approaches. Meta-analyses of the published allo-HCT versus auto-HCT studies have confirmedthat although CR rates are higher for allo-HCT, so are the rates of treatment-related mortality. Thus, a consistentPFS or OS benefit for allo-HCT cannot be demonstrated.
Nina Shah et al, Hematopoietic Stem Cell Transplantation for MultipleMyeloma: Guidelines from the American Society for Bloodand Marrow Transplantation
Bruno B et al. A comparison of allografting with autografting for newly diagnosed myeloma. N Engl J Med 2007 Mar 15; 356:1110-20.
Bruno B, Rotta M, Patriarca F, et al. Double autologous transplant versus tandem autologous – non myeloablative allogeneic transplant for newly diagnosed multiple myeloma. Blood. 2005;106;18a, abstract 46.
Benedetto Bruno, Luisa Giaccone, Moreno Festuccia, and Mario Boccadoro Role of Allogeneic Transplantation in Multiple Myeloma in the Era of New Drugs Mediterr J Hematol Infect Dis. 2010; 2(2)