A randomized trial comparing chemotherapy plus lenalidomide with ASCT followed by maintenance with lenalidomide-prednisone or lenalidomide alone in patients with newly diagnosed myeloma demonstrated significantly prolonged progression-free survival (PFS) in the transplant arm (60% vs 38% at 3 years). Unfortunately, these studies predated novel agents, and with current survival rates, it is fair to ask whether ASCT still has a role. In the 2 largest studies, 1, 2 autologous stem cell transplantation (ASCT) showed a 12-month improvement in overall survival compared with nontransplant cohorts.
Is there any role for stem cell transplantation in the novel-agent era? She represents the 10% of patients whose response duration after a second transplantation exceeds that of the first.
She achieved a complete response (CR) and has been in continuous remission for 9 years and 3 months since then she now survives 17.7 years after development of overt myeloma. She underwent a second stem cell transplantation (conditioned with melphalan ) in September 2004 using cells cryopreserved in October 1996. At day 100, she had achieved a very good partial response (VGPR) she remained in remission for 43.6 months, when IgG levels doubled to 1420 mg/dL. She went directly to stem cell transplantation and was conditioned with melphalan (200 mg/m 2). She had progression in September 1998, with an IgG that rose from 1960 to 2940 mg/dL. She deferred stem cell transplantation and was treated with vincristine, carmustine, melphalan, cyclophosphamide, and prednisone between November 1996 and October 1997. After 4 cycles, stem cells were collected and cryopreserved. She began treatment with vincristine, doxorubicin, and dexamethasone. She had compression fractures of L2 and L5. In April 1996, anemia developed (hemoglobin, 8.6 g/dL), a bone marrow biopsy showed 73% plasma cells, and her immunoglobulin (Ig) G level was 5740 mg/dL. She initially had expectant management only. A bone marrow biopsy showed 49% plasma cells. A review of the data on tandem vs sequential autologous transplants is provided.Ī 50-year-old woman had asymptomatic multiple myeloma identified in December 1992. Specific guidelines on mobilization and supportive care through the transplant course, as done at Mayo Clinic, are given. We provide selection criteria that minimize the risks of transplantation. We review the data justifying use of stem cell transplantation as initial management in myeloma patients. The most common indication for autologous stem cell transplantation in the United States is multiple myeloma, and this article is designed to provide the specifics of organizing a transplant program for multiple myeloma.
The rate of new myeloma cases has been rising 0.7% per year during the past decade. The median age at diagnosis is 69 years, with 62.4% of patients aged 65 or older at diagnosis. Approximately 0.7% of US men and women will have a myeloma diagnosis in their lifetime, and with advances in therapy, 77 600 US patients are living with myeloma. An estimated 22 350 patients had multiple myeloma diagnosed in 2013, representing 1.3% of all new cancers 10 710 deaths are projected, representing 1.8% of cancer deaths.