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Tandem Transplants Increase CR, Reduce Treatment Mortality in Multiple Myeloma

Tandem Transplants Increase CR, Reduce Treatment Mortality in Multiple Myeloma

SEATTLE—A two-stage procedure that combines high-dose chemotherapy with
autologous stem cell transplantation (SCT) with an immunosuppressive (but
not myeloablative) allogeneic SCT in multiple myeloma improves complete
response rate and decreases treatment-related mortality.

In a plenary presentation at the 43rd Annual Meeting of the American
Society of Hematology, David G. Maloney, MD, PhD, presented data for 41
patients treated with this approach. "The reduced mortality allows
treatment of older patients. We feel our method should now be studied in
comparison to conventional autografting for the treatment of patients with
myeloma," said Dr. Maloney, who is an associate member of the Fred
Hutchinson Cancer Research Center in Seattle.

Treatment-Related Mortality an Issue

In introducing this paper, Stephen Mackinnon, MD, pointed to
treatment-related mortality as a major flaw in conventional transplants.
"We are still losing one out of three of our transplant patients to
transplant-related causes. In addition, conventional transplants are
generally not applicable to older patients, because age is associated with
increased risk. That is a problem, as most multiple myeloma patients are
elderly." Dr. Mackinnon is a consultant in hematology at University
College in London.

The lower-intensity regimen Dr. Maloney used to prepare patients for the
allogeneic SCT is myelosuppressive rather than myeloablative. It has limited
antitumor efficacy but is immunosuppressive enough to permit transplant
engraftment, according to Dr. Mackinnon. The main difference compared to
conventional regimens is in the use of low-dose total-body irradiation.

Dr. Maloney said that although myeloablative allogeneic SCT is
potentially curative for myeloma (due to the graft-vs-myeloma effect), his
group has been concerned about high transplant-related mortality due to
regimen-related toxicities and graft-vs-host disease. "The alternative
of high-dose therapy with autologous stem cell rescue induces cytoreduction
of the disease with a low transplant-related mortality, but nearly all
patients eventually relapse or develop disease progression," he said.

Therapy Could Be Curative


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