Multiple myeloma treatment: Transplantation
High-dose chemotherapy and autologous stem cell transplantation
Since the nineteens, the new protocols consisting of 3 of 5 cycles of conventional induction chemotherapy prior to high-dose chemotherapy and autologous stem cell transplantation or peripheral blood stem cell transplantation represent a standard treatment option for patients younger than 65 (70) of age with good performance status.
The optimal induction chemotherapy prior to autologous transplantation is considered to be VAD chemoptherapy (vincristine, adriamycin and dexamethasone) minimising damage to stem hematopoetic cells and enabling the stem cell harvest in quantity sufficient for several autologous trasplantations. These medical protocols achieve better responses than conventional therapy.
Allogenic stem cell transplantation
The medical protocols featuring induction chemotherapy prior to allogenic stem cell transplantation still carries the risk of relatively high procedure-related mortality. According to the European transplant registry from 2000, the early procedure-related mortality rate was 30 % and the overall mortality rate 50 % in 1983-1993. In 1994-1998, the early mortality was reduced to 20 % and the overall mortality to 30 %.
The median survival time in patients that have undergone allogenic transplantation isn´t still higher than in patients that have undergone autologous transplantation with a mortality rate of approximately 3%. Most notably, the remission duration in patients having survived the first year following allogenic transplantation is significantly longer than in patients having undergone the autologous transplantation.
Therefore, the allogenic transplantation is considered to be appropriate for selected patients with frequent relapsees of the disease but not for newly diagnosed patietns.
These facts raise question whether it is ethical to propose allogenic transplantation as a treatment option to every young patient that has got an eligible donor.
Considering the risks associated with allogenic transplantation and considering the long-term immunosupression or the graft-versus-host reaction, the early allogenic transplantation seems to be appropriate in patients with defined unfavourable prognostic factors (chromosome 13 delection, beta}2-microglobulin value > 4mg/l at standard level of creatinine).