Transplantation for Multiple Myeloma
Multiple myeloma is a disorder characterized by accumulation of malignant plasma cells in the bone marrow, hypercalcemia, monoclonal protein, and end organ damage. Recently newer generation proteosome inhibitors, monoclonal antibodies and novel agents hav
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Abstract
Multiple myeloma is a disorder characterized by accumulation of malignant plasma cells in the bone marrow, hypercalcemia, monoclonal protein, and end organ damage. Recently newer generation proteosome inhibitors, monoclonal antibodies and novel agents have been approved by FDA, which is undoubtedly increasing life expectancy of the patients. However, hematopoietic stem cell transplantation still remains the cornerstone of the treatment. In this chapter, we are discussing the autologous stem cell transplant, allogeneic stem cell transplant and total therapy trials with outcomes. Keyword
Myeloma transplant
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Stem
cell transplant
Tandem transplants Clinical trials
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Introduction
A Surveillance Epidemiology and End Results (SEER) data indicate that the number of new cases of multiple myeloma (MM) was 6.3 per 100,000 men and women per year. Multiple myeloma is the most common indication for autologous stem cell transplantation (AT). AT is still considered the standard of care for multiple myeloma (MM) patients. In the USA, eligibility for hemopoetic stem cell Y.S. Jethava (&) F. van Rhee Stem Cell and Allogeneic Transplant, Department of Hematology/Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA e-mail: [email protected] © Springer International Publishing Switzerland 2016 A.M. Roccaro and I.M. Ghobrial (eds.), Plasma Cell Dyscrasias, Cancer Treatment and Research 169, DOI 10.1007/978-3-319-40320-5_13
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transplant (HSCT) is principally determined by biological fitness rather than age while in Europe, patients are often considered who are 65 years or younger. New chemotherapeutic agents (e.g., bortezomib, thalidomide, lenalidomide) are being incorporated into treatment paradigm for multiple myeloma as a result, outcomes with AT have been improving. Recent studies with long-term follow-up suggest that cure is now feasible for subsets of patients.
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Advances in Disease Biology and Risk-Adapted Treatment
Several algorithms for the management of myeloma have been suggested. Most of these incorporate cytogenetics and standard prognostic factors such as serum albumin and beta 2 microglobulin [1]. The cytogenetic-based risk stratification model is demonstrated in Table 1. Apart from the cytogenetic-based risk model, gene expression profiling offers more robust way of risk stratification of MM [2]. So far, GEP is available in large institutions and the disadvantages of GEP include sample attrition (especially in multicenter trials), expense, requirement for stringent quality control, and sample turnaround time, which limits application. The introduction of a “myeloma PCR kit” has negated these issues and is enabling genetic stratification based on biologic disease risk. Based on RT-PCR data of 70 genes, MM patients are divided into standard risk and high-risk groups. High-risk patients do poorly with all current approaches and should be entered into clinical trials exploring novel therapies and combination of novel drugs. It is concei
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