Combination Autologous/Allogeneic Transplant More Effective in Multiple Myeloma

Combination Autologous/Allogeneic Transplant More Effective than Double Autologous Transplants in Multiple Myeloma.

According to results recently presented at the 47th annual meeting of the American Society of Hematology, treatment consisting of an autologous stem cell transplant followed by a mini allogeneic transplant appears to provide better overall survival than two autologous transplants for newly diagnosed patients with multiple myeloma.

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. Myeloma may also damage the kidneys and cause osteoporosis, anemia, and an elevated blood calcium level.

A stem cell transplant is a procedure that utilizes high doses of therapy to kill more cancer cells than conventional doses. Unfortunately, the higher doses tend to destroy important hematopoietic stem cells (immature blood cells). 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.

There are two general types of stem cell transplants; an autologous transplant and an allogeneic transplant. During an autologous transplant, the patients own hematopoietic stem cells are collected prior to therapy, frozen, and then re-infused following high-dose treatment. During an allogeneic transplant, a donors hematopoietic stem cells are collected and infused into the patient.

In addition to restoring low levels of a patients stem cells following therapy, donor stem cells also attack the patients cancer cells. During a mini, or reduced-intensity allogeneic stem cell transplant, treatment doses are used that are not as high or intense as regular transplants; donor stem cells provide the anticancer activity.

Unfortunately, donor stem cells may also attack a patients healthy tissues, a condition referred to as graft-versus-host-disease (GVHD). Research continues into ways to reduce GVHD without compromising the effectiveness of donor stem cells.

Mini allogeneic stem cell transplants are being evaluated as treatment for a number of cancers. They appear to provide anticancer activity with a reduction in treatment-associated mortality.

Researchers from Italy recently conducted a clinical trial to compare treatment with two (tandem) autologous stem cell transplants to an autologous stem cell transplant followed by a mini-allogeneic transplant (auto-allo) in patients with newly diagnosed multiple myeloma. This trial included 73 patients who underwent tandem autologous stem cell transplants and 56 who underwent an autologous stem cell transplant followed by a mini-allogeneic transplant. Patients who underwent an autologous transplant followed by a mini-allogeneic transplant had improved outcomes:

  • Treatment-related mortality was 4% for those undergoing tandem autologous transplants and 11% for those undergoing auto-allo transplants.
  • Overall survival was 83% for those who underwent auto-allo transplants and 58% for those who underwent tandem autologous transplants.
  • Progression-free survival was 75% for those who underwent auto-allo transplants and 41% for those who underwent tandem autologous transplants.
  • Complete disappearance of cancer (complete remission) was achieved in 54% of patients who underwent auto-allo transplants, compared with 26% who underwent tandem autologous transplants.

The researchers concluded that an autologous stem cell transplant followed by a mini allogeneic transplant appears to provide superior outcomes, including survival, to tandem autologous transplants in patients with newly diagnosed multiple myeloma. However, not all patients are eligible for stem cell transplant procedures; it is therefore important for patients to speak with their physician regarding their individual risks and benefits of each treatment option.

Reference: Bruno B, Rotta M, Patriarca F, et al. Double autologous transplant versus tandem autologous non myeloablative allogeneic transplant for newly diagnosed multiple myeloma. Proceedings from the 47th annual meeting of the American Society of Hematology. Blood. 2005;106;18a, abstract 46.

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