Auto-SCT Followed by Allo-SCT Superior to Two Autologous Transplants in MM

Autologous Transplant Followed by Allogeneic Transplants Superior to Two Autologous Transplants in Multiple Myeloma

According to an article recently published in the New England Journal of Medicine, among patients with newly diagnosed multiple myeloma, treatment with an autologous stem cell transplant followed by an allogeneic stem cell transplant with a matched sibling donor provides superior survival compared with two autologous stem cell transplants.

Multiple myeloma is a cancer of the blood that affects the plasma cells. Plasma cells are an important part of the immune system; they produce antibodies to help fight infection and disease. Multiple myeloma is characterized by an excess production of abnormal plasma cells. Symptoms include increased risk of bacterial infections and impaired immune responses.

A standard treatment option for patients with multiple myeloma is stem cell transplantation. Stem cell transplantation involves the use of high doses of chemotherapy and/or radiation therapy. These high doses kill more cancer cells than standard doses; however, the high doses also kill more healthy cells. Hematopoietic stem cells (immature blood cells) are particularly vulnerable to high-dose therapy. These stem cells mature into red blood cells, which transport oxygen and nutrients to tissues in the body; white blood cells, which help the body fight infection; and platelets, which aid the blood in clotting.

Low levels of hematopoietic stem cells caused by high-dose treatment can result in life-threatening conditions. In an effort to prevent this condition, hematopoietic stem cells from a donor (allogeneic) or from the patient (autologous) are infused into the patient following therapy. Hematopoietic stem cells may be obtained from umbilical cord blood immediately following the birth of a child (cells are then frozen and stored in a central facility), from peripheral (circulating) blood, or in the bone marrow (spongy material inside large bones). Researchers have been evaluating the effectiveness of autologous and allogeneic stem cell transplants, either as single or double transplants, in the treatment of multiple myeloma.

Researchers from Italy and the University of Washington recently conducted a clinical study to evaluate the effectiveness of double autologous stem cell transplants versus an autologous stem cell transplant followed by an allogeneic stem cell transplant in the treatment of multiple myeloma. This trial included 162 patients who were 65 years of age or younger and had newly diagnosed multiple myeloma. After patients were treated with an autologous stem cell transplant, one group was then treated with an additional autologous stem cell transplant, and the other group was treated with an allogeneic stem cell transplant with stem cells from a sibling. The following results were reported at a median of 45 months follow-up:

  • Mortality caused by multiple myeloma occurred in 43% of patients treated with a double autologous stem cell transplant, compared with only 7% for patients treated with an autologous/allogeneic treatment strategy.
  • Median overall survival was improved among patients treated with matched sibling donor stem cells, compared with patients treated with non-matched sibling donor stem cells.
  • Mortality related to treatment was not significantly different between the two groups of patients.

The researchers concluded that survival is significantly improved among patients newly diagnosed with multiple myeloma who are younger than 65 years of age and receive an autologous stem cell transplant followed by an allogeneic transplant with a matched sibling donor when compared with those treated with two autologous stem cell transplants.

Patients newly diagnosed with multiple myeloma who are 65 years or younger may wish to speak with their physician regarding their individual risks and benefits of treatment with stem cell transplantation.

Reference: Bruno B, Rotta M, Patriarca F, et al. A comparison of allografting with autografting for newly diagnosed myeloma. New EnglandJournal of Medicine. 2007; 356:1110-1120.

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