Here is a Spanish, pro-transplant study abstract, recently published in Blood:
Submitted August 21, 2009; accepted February 16, 2010.
Hematopoietic stem cell transplantation for multiple myeloma beyond 2010
Joan Bladé*, Laura Rosiñol, Maria Teresa Cibeira, Montserrat Rovira and Enric Carreras
1 Department of Hematology and Bone Marrow Transplant Unit, Institut of Hematology and Oncology, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
* Corresponding author; email: email@example.com
Autologous stem cell transplantation (ASCT) is considered the gold standard in the frontline therapy of younger patients with multiple myeloma, since it results in higher complete remission (CR) rates and longer event-free survival (EFS) than conventional chemotherapy. The greatest benefit from ASCT is obtained in patients achieving CR post-transplant, the likelihood of CR being associated with the M-protein size at the time of transplant. The incorporation of novel agents results in higher pre- and post-transplant CR rates. Induction with bortezomib-containing regimens is encouraging in patients with poor-risk cytogenetics. However, longer follow-up is required to assess the impact of this increased CR on long-term survival. The results of post-transplant consolidation/maintenance with new drugs are encouraging. All the above indicate that, in the era of novel agents, high-dose therapy should be optimized rather than replaced. Due to its high transplant-related mortality, myeloablative allografting has been generally replaced by reduced-intensity conditioning (Allo-RIC). The best results are achieved after a debulky ASCT, with a progression-free survival plateau of 25-30% beyond 6 years from Allo-RIC. The development of novel reduced-intensity preparative regimens and peri- and –post-transplant strategies aimed at minimizing graft-versus-host disease and enhancing the graft-versus-myeloma effect are key issues.
Hard to argue with that—but I still think more patients should harvest first—then wait before proceeding to SCT, as long as induction therapy is working well.
Feel good and keep smiling! Pat