Changing paradigms in refractory myeloma autologous stem cell transplantation- pro
The traditional approach to ASCT before the introduction of novel agents had been initial control of the disease using combination regimens such as vincristine, doxorubicin and dexamethasone (VAD) or single agent dexamethasone. The type of pretransplant therapy did not appear to have much impact on the outcome of SCT and likely reflects the low rates of deep responses [very good partial response (VGPR) and complete responses] seen with these regimens. However, alkylating agents are avoided as part of initial therapy due to their impact on the ability to collect stem cells. The role of induction chemotherapy prior to HDT/ASCT is to decrease tumor burden, thus deepening the response rate and increasing the likelihood of engraftment, while retaining the maximum possible tolerability and minimum possible toxicity on normal hematopoietic cells. The depth of response after induction and before ASCT determines patients’ prognoses after ASCT since the quality of response post induction and prior to ASCT are predictive of long-term PFS post ASCT1. Following 4–6 months of therapy, patients underwent stem cell collection with granulocyte colony-stimulating factor alone or in combination with chemotherapy, followed by immediate transplantation or continuation of alkylator or steroid-based treatment regimens with the aim of delayed transplantation at relapse.
However, recent evidence suggests that patients\s who do not respond to initial chemotherapy are still good candidates for autologous stem cell transplantation.In the Spanish Myeloma Group 2000 trial, 80 patients with primary refractory myeloma (49 with stable disease and 31 with progressive disease), i.e. who were refractory to initial chemotherapy, were scheduled for tandem transplants (double autologous transplant or a single autologous transplant followed by an allogeneic transplant). This ahs led to upfront intervention with autologous s
tem cell transplantation becoming widespread and generally accepted.
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Rosiñol L, García-Sanz R, Lahuerta JJ, et al. Benefit from autologous stem cell transplantation in primary refractory myeloma? Different outcomes in progressive versus stable disease. Haematologica. 2012;97(4):616–621. doi:10.3324/haematol.2011.051441
Rama Al Hamed et al ,Current status of autologous stem cell transplantation for multiple myeloma. Blood Cancer Journal Published: 08 April 2019