Which high-risk patients with multiple myeloma (MM) are potential transplant candidates?

Updated: Jul 15, 2019
  • Author: Dhaval Shah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

High-risk MM patients are those with advanced-stage disease (stage III according to the International Staging System); those with poor cytogenetics, such as t (4:14), t (14:16), and t (14:20), deletion of chromosome 13, inactivation of TP53; and those with a complex karyotype. Patients with very high proliferative rates are also included in this classification.

This group represents about 25% of those with newly diagnosed MM, with an expected median survival of 2 years or less. Although they respond to traditional therapies for induction, these individuals tend to relapse rapidly. Therefore, novel agents should be considered up front for these patients.

The advent of thalidomide, lenalidomide, and bortezomib has substantially improved outcomes in these high-risk groups. In fact, these novel agents appear to overcome the influence contributed by high-risk cytogenetics. [58, 59] Once a response has been achieved, then these patients can be brought to autologous stem cell transplantation.


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