How does stem cell transplantation affect other treatment decisions in patients with multiple myeloma?

Updated: Dec 31, 2018
  • Author: Sara J Grethlein, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Answer

In general, the first decision made in the management of patients with myeloma who require systemic therapy is whether stem cell transplantation is part of the strategy. Considerations are as follows:

  • Alkylator and nitrosourea therapy is usually deferred or reduced in patients who may require autologous stem cell collection, to avoid injury to the stem cells

  • A single autologous stem cell transplant has been associated with superior event-free survival compared with chemotherapy and is considered the preferred approach [1]

  • As newer agents (bortezomib, thalidomide, and lenalidomide) are studied, the role of transplantation will continue to evolve

  • Induction chemotherapy followed by autologous stem cell support is widely used as treatment in patients with multiple myeloma; however, there is growing evidence that only the subset of patients who achieve complete remission (CR) actually benefit from this approach [2]

  • Complete remission is defined as negative serum and urine immunofixation, disappearance of soft-tissue plasmacytomas, and < 5% plasma cells in bone marrow [3]


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