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The evolving background for high-dose treatment for myeloma

Abstract

In the constantly evolving field of myeloma, this special issue is slanted towards how the newer targeted treatments fit in with various transplantation strategies. High-dose treatment for myeloma with autologous stem cell transplantation started 25 years ago, with the consequence of producing complete remissions and a doubling of survival. Since then, its role has been refined and it has been accepted as standard treatment. The current challenge is to optimize its use into a background of the development, availability and regulatory approval of newer targeted therapies such as Thalidomide, Revlimid (Lenalidomide) and Velcade (Bortezomib). This special issue addresses these problems, and gives particular emphasis on the attainment of very long-term survival, with normal quality of life for patients with myeloma who do not necessarily need to be cured of their molecular disease, that is, they are ‘operationally cured.’ It is hoped that the reader will find the information in this issue useful in the day-to-day management of patients and we hope that this will also inspire new research directions designed to improve the outcome of patients with myeloma.

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References

  1. Attal M, Harousseau JL, Stoppa AM, Sotto JJ, Fuzibet JG, Rossi JF et al. Prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. New Engl J Med 1996; 355: 91–97.

    Article  Google Scholar 

  2. Attal M, Harousseau JL, Facon T, Guilhot F, Doyen C, Fuzibet JG et al. Single versus double autologous stem-cell transplantation for multiple myeloma. N Engl J Med 2003; 349: 2495–2502.

    Article  CAS  Google Scholar 

  3. Bruno B, Rotta M, Patriarca F, Mordini N, Allione B, Carnevale-Schianca F et al. A comparison of allografting with autografting for newly diagnosed myeloma. N Engl J Med 2007; 356: 1110–1120.

    Article  CAS  Google Scholar 

  4. Maloney DG, Molina AJ, Sahebi F, Stockerl-Goldstein KE, Sandmaier BM, Bensinger W et al. Allografting with nonmyeloablative conditioning following cytoreductive autografts for the treatment of patients with multiple myeloma. Blood 2003; 102: 3447–3454.

    Article  CAS  Google Scholar 

  5. Sirohi B, Powles R, Mehta J, Rudin C, Kulkarni S, Horton C et al. An elective single autograft with high-dose melphalan: single-center study of 451 patients. Bone Marrow Transplant 2005; 36: 19–24.

    Article  CAS  Google Scholar 

  6. Selby PJ, McElwain TJ, Nandi AC, Perren TJ, Powles RL, Tillyer CR et al. Multiple myeloma treated with high-dose intravenous melphalan. Br J Haematol 1987; 66: 52–55.

    Article  Google Scholar 

  7. McElwain TJ, Powles RL . High-dose intravenous melphalan for plasma cell leukaemia and myeloma. Lancet 1983; 2: 822–824.

    Article  CAS  Google Scholar 

  8. Barlogie B, Hall R, Zander A, Dicke K, Alexanian R . High-dose melphalan with autologous bone marrow transplantation for multiple myeloma. Blood 1986; 67: 1298–1301.

    CAS  Google Scholar 

  9. Gahrton G, Tura S, Ljungman P, Belanger C, Brandt L, Cavo M et al. Allogeneic bone marrow transplantation in multiple myeloma. European group for bone marrow transplantation. N Engl J Med 1991; 325: 1267–1273.

    Article  CAS  Google Scholar 

  10. Powles R, Raje N, Milan S, Millar B, Shepherd V, Mehta J et al. Outcome assessment of a population based group of 195 patients under 70 years of age offered intensive treatment. Bone Marrow Transplant 1997; 20: 435–443.

    Article  CAS  Google Scholar 

  11. Barlogie B, Jagannath S, Desikan KR, Mattox S, Vesole D, Siegel D et al. Total therapy with tandem transplants for newly diagnosed multiple myeloma. Blood 1999; 93: 55–65.

    CAS  PubMed  Google Scholar 

  12. Storb R, Yu C, Sandmaier B, McSweeney P, Georges G, Nash R et al. Mixed hematopoietic chimerism after hematopoietic stem cell allografts. Transplant Proc 1999; 31: 677–678.

    Article  CAS  Google Scholar 

  13. Child JA, Morgan GJ, Davies FE, Owen RG, Bell SE, Hawkins K et al. High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med 2003; 348: 1875–1883.

    Article  CAS  Google Scholar 

  14. Johnson W, Kerridge I, Milton C, Carr D, Enno A, Bray L et al. Hospital in the home (HITH) care following autologous stem cell transplantation for lymphoma and multiple myeloma. Aust J Adv Nurs 2006; 23: 34–39.

    PubMed  Google Scholar 

  15. Palumbo A, Bringhen S, Caravita T, Merla E, Capparella V, Callea V et al. Oral melphalan and prednisone chemotherapy plus thalidomide compared with melphalan and prednisone alone in elderly patients with multiple myeloma: randomised controlled trial. Lancet 2006; 367: 825–831.

    Article  CAS  Google Scholar 

  16. Koreth J, Cutler CS, Djulbegovic B, Behl R, Schlossman RL, Munshi NC et al. High-dose therapy with single autologous transplantation versus chemotherapy for newly diagnosed multiple myeloma: a systematic review and meta-analysis of randomized controlled trials. Biol Blood Marrow Transplant 2007; 13: 183–196.

    Article  CAS  Google Scholar 

  17. Sirohi B, Powles R, Lawrence D, Treleaven J, Kulkarni S, Leary A et al. An open, randomized, controlled, phase II, single centre, two-period cross-over study to compare the quality of life and toxicity experienced on PEG interferon with interferon-{alpha}2b in patients with multiple myeloma maintained on a steady dose of interferon-{alpha}2b. Ann Oncol 2007; 18: 1388–1394.

    Article  CAS  Google Scholar 

  18. Attal M, Harousseau JL, Leyvraz S, Doyen C, Hulin C, Benboubker L et al. Maintenance therapy with thalidomide improves survival in patients with multiple myeloma. Blood 2006; 108: 3289–3294.

    Article  CAS  Google Scholar 

  19. Kulkarni S, Powles RL, Treleaven JG, Singhal S, Saso R, Horton C et al. Impact of previous high-dose therapy on outcome after allografting for multiple myeloma. Bone Marrow Transplant 1999; 23: 675–680.

    Article  CAS  Google Scholar 

  20. Durie BGM, Salmon SE . A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Cancer 1975; 36: 842–854.

    Article  CAS  Google Scholar 

  21. Greipp PR, San Miguel J, Durie BG, Crowley JJ, Barlogie B, Bladé J et al. International staging system for multiple myeloma. J Clin Oncol 2005; 23: 3412–3420.

    Article  Google Scholar 

  22. Sirohi B, Powles R, Mehta J, Raje N, Kulkarni S, Ramiah V et al. Complete remission rate and outcome after intensive treatment of 177 patients under 75 years of age with IgG myeloma defining a circumscribed disease entity with a new staging system. Br J Haematol 1999; 107: 656–666.

    Article  CAS  Google Scholar 

  23. Gore ME, Selby PJ, Viner C, Clark PI, Meldrum M, Millar B et al. Intensive treatment of multiple myeloma and criteria for complete remission. Lancet 1989; 2: 879–881.

    Article  CAS  Google Scholar 

  24. Blade J, Samson D, Reece D, Apperley J, Björkstrand B, Gahrton G et al. Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haemopoietic stem cell transplantation. Myeloma subcommittee of the EBMT. European group for blood and marrow transplant. Br J Haematol 1998; 102: 1115–1123.

    Article  CAS  Google Scholar 

  25. Durie BG, Harousseau JL, Miguel JS, Bladé J, Barlogie B, Anderson K et al. International uniform response criteria for multiple myeloma. Leukemia 2006; 20: 1467–1473.

    Article  CAS  Google Scholar 

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Correspondence to R Powles.

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Sirohi, B., Powles, R., Harousseau, J. et al. The evolving background for high-dose treatment for myeloma. Bone Marrow Transplant 40, 1097–1100 (2007). https://doi.org/10.1038/sj.bmt.1705867

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