High-dose chemotherapy and autologous hematopoietic stem cell transplantation in myeloma patients under the age of 65 years
- 6 August 2007
- journal article
- review article
- Published by Springer Science and Business Media LLC in Bone Marrow Transplantation
- Vol. 40 (12), 1101-1114
- https://doi.org/10.1038/sj.bmt.1705799
Abstract
One or two cycles of high-dose chemotherapy with autologous hematopoietic stem cell transplantation have been shown to improve response rates and survival in myeloma. While this observation has largely been made in patients under the age of 65 years, there is evidence to suggest that the conclusions can be extrapolated to older individuals as well. In contrast to other hematologic malignancies treated with high-dose therapy, autografted myeloma patients continue to relapse several years after transplantation, and few patients are cured with this modality. However, up to a third of patients may be alive beyond a decade; some with excellent quality of life giving rise to the concept of 'operational cure'. Relapsing disease can be treated with novel agents or repeat high-dose chemotherapy and transplantation. The pressing questions to which answers are not obvious at the moment are whether tandem transplantation should be offered to all patients, and whether novel agents should be used before transplantation or reserved for relapse. Despite their excellent activity, there is no evidence so far that novel agents such as thalidomide, bortezomib and lenalidomide can replace high-dose chemotherapy and stem cell transplantation.Keywords
This publication has 74 references indexed in Scilit:
- International uniform response criteria for multiple myelomaLeukemia, 2006
- Phase III Clinical Trial of Thalidomide Plus Dexamethasone Compared With Dexamethasone Alone in Newly Diagnosed Multiple Myeloma: A Clinical Trial Coordinated by the Eastern Cooperative Oncology GroupJournal of Clinical Oncology, 2006
- High-dose therapy and autologous stem cell transplantation for multiple myeloma poorly responsive to initial therapyBone Marrow Transplantation, 2004
- Single versus Double Autologous Stem-Cell Transplantation for Multiple MyelomaNew England Journal of Medicine, 2003
- Impact of cytogenetics on the outcome of autotransplantation for acute myeloid leukemia in first remission: is the benefit of intensive pretransplant therapy limited to patients with good karyotypes?Bone Marrow Transplantation, 2003
- Antitumor Activity of Thalidomide in Refractory Multiple MyelomaNew England Journal of Medicine, 1999
- Graft-versus-myelomaBone Marrow Transplantation, 1998
- CRITERIA FOR EVALUATING DISEASE RESPONSE AND PROGRESSION IN PATIENTS WITH MULTIPLE MYELOMA TREATED BY HIGH‐DOSE THERAPY AND HAEMOPOIETIC STEM CELL TRANSPLANTATIONBritish Journal of Haematology, 1998
- Outcome assessment of a population-based group of 195 unselected myeloma patients under 70 years of age offered intensive treatmentBone Marrow Transplantation, 1997
- Intensive chemotherapy with blood progenitor transplantation for primary resistant multiple myelomaBritish Journal of Haematology, 1994