Current Hematologic Malignancy Reports

, Volume 2, Issue 2, pp 121–127

Role of autologous stem cell transplantation in multiple myeloma



High-dose chemotherapy with autologous stem cell transplantation (ASCT) has been shown to improve survival in patients with multiple myeloma in randomized trials and is the standard of care for eligible patients. Recent randomized trials suggest a survival benefit with tandem ASCT, notably for patients failing to achieve a very good response to initial transplantation. Other randomized trials, as well as smaller phase II trials and retrospective studies, have allowed us to improve the process of ASCT in terms of the stem cell collection, conditioning regimens, and extension of the therapy to a wider patient population. The introduction of thalidomide, lenalidomide, and bortezomib have changed the paradigm for treatment of myeloma and significantly improved the outcome for these patients. The role of ASCT will clearly be redefined in the coming years with improvements in other therapies.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    McElwain TJ, Powles RL: High-dose intravenous melphalan for plasma-cell leukaemia and myeloma. Lancet 1983, 2:822–824.PubMedCrossRefGoogle Scholar
  2. 2.
    Selby P, Zulian G, Forgeson G, et al.: The development of high dose melphalan and of autologous bone marrow transplantation in the treatment of multiple myeloma: Royal Marsden and St. Bartholomew’s Hospital studies. Hematol Oncol 1988, 6:173–179.PubMedCrossRefGoogle Scholar
  3. 3.
    Barlogie B, Alexanian R, Dicke KA, et al.: High-dose chemoradiotherapy and autologous bone marrow transplantation for resistant multiple myeloma. Blood 1987, 70:869–872.PubMedGoogle Scholar
  4. 4.
    Attal M, Harousseau JL, Stoppa AM, et al., for the Intergroupe Français du Myélome: A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. N Engl J Med 1996, 335:91–97.PubMedCrossRefGoogle Scholar
  5. 5.
    Harousseau JL, Attal M: The role of stem cell transplantation in multiple myeloma. Blood Rev 2002, 16:245–253.PubMedCrossRefGoogle Scholar
  6. 6.
    Child JA, Morgan GJ, Davies FE, et al.; Medical Research Council Adult Leukaemia Working Party: High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med 2003, 348:1875–1883.PubMedCrossRefGoogle Scholar
  7. 7.
    Fermand JP, Katsahian S, Divine M, et al.: High-dose therapy and autologous blood stem-cell transplantation compared with conventional treatment in myeloma patients aged 55 to 65 years: long-term results of a randomized control trial from the Groupe Myelome-Autogreffe. J Clin Oncol 2005, 23:9227–9233.PubMedCrossRefGoogle Scholar
  8. 8.
    Barlogie B, Kyle RA, Anderson KC, et al.: Standard chemotherapy compared with high-dose chemoradiotherapy for multiple myeloma: final results of phase III US Intergroup Trial S9321. J Clin Oncol 2006, 24:929–936.PubMedCrossRefGoogle Scholar
  9. 9.
    Blade J, Rosinol L, Sureda A, et al.: High-dose therapy intensification compared with continued standard chemotherapy in multiple myeloma patients responding to the initial chemotherapy: long-term results from a prospective randomized trial from the Spanish cooperative group PETHEMA. Blood 2005, 106:3755–3759.PubMedCrossRefGoogle Scholar
  10. 10.
    Palumbo A, Bringhen S, Petrucci MT, et al.: Intermediate-dose melphalan improves survival of myeloma patients aged 50 to 70: results of a randomized controlled trial. Blood 2004, 104:3052–3057.PubMedCrossRefGoogle Scholar
  11. 11.
    Fermand JP, Ravaud P, Chevret S, et al.: High-dose therapy and autologous peripheral blood stem cell transplantation in multiple myeloma: up-front or rescue treatment? Results of a multicenter sequential randomized clinical trial. Blood 1998, 92:3131–3136.PubMedGoogle Scholar
  12. 12.
    Siegel DS, Desikan KR, Mehta J, et al.: Age is not a prognostic variable with autotransplants for multiple myeloma. Blood 1999, 93:51–54.PubMedGoogle Scholar
  13. 13.
    Badros A, Barlogie B, Siegel E, et al.: Autologous stem cell transplantation in elderly multiple myeloma patients over the age of 70 years. Br J Haematol 2001, 114:600–607.PubMedCrossRefGoogle Scholar
  14. 14.
    Kumar S, Lacy M, Dispenzieri A, et al.: Autologous stem cell transplantation for multiple myeloma in patients over 70 years: a matched comparison with patients under 65 years [abstract]. ASH Annual Meeting Abstracts 2005, 106:1173.Google Scholar
  15. 15.
    San Miguel JF, Lahuerta JJ, Garcia-Sanz R, et al.: Are myeloma patients with renal failure candidates for autologous stem cell transplantation? Hematol J 2000, 1:28–36.PubMedCrossRefGoogle Scholar
  16. 16.
    Knudsen LM, Nielsen B, Gimsing P, Geisler C: Autologous stem cell transplantation in multiple myeloma: outcome in patients with renal failure. Eur J Haematol 2005, 75:27–33.PubMedCrossRefGoogle Scholar
  17. 17.
    Lee CK, Zangari M, Barlogie B, et al.: Dialysis-dependent renal failure in patients with myeloma can be reversed by high-dose myeloablative therapy and autotransplant. Bone Marrow Transplant 2004, 33:823–828.PubMedCrossRefGoogle Scholar
  18. 18.
    Knudsen LM, Rasmussen T, Jensen L, Johnsen HE: Reduced bone marrow stem cell pool and progenitor mobilisation in multiple myeloma after melphalan treatment. Med Oncol 1999, 16:245–254.PubMedGoogle Scholar
  19. 19.
    Singhal S, Powles R, Sirohi B, et al.: Response to induction chemotherapy is not essential to obtain survival benefit from high-dose melphalan and autotransplantation in myeloma. Bone Marrow Transplant 2002, 30:673–679.PubMedCrossRefGoogle Scholar
  20. 20.
    Bensinger WI, Buckner CD, Anasetti C, et al.: Allogeneic marrow transplantation for multiple myeloma: an analysis of risk factors on outcome. Blood 1996, 88:2787–2793.PubMedGoogle Scholar
  21. 21.
    Harousseau JL, Attal M, Divine M, et al.: Comparison of autologous bone marrow transplantation and peripheral blood stem cell transplantation after first remission induction treatment in multiple myeloma [review]. Bone Marrow Transplant 1995, 15:963–969.PubMedGoogle Scholar
  22. 22.
    Larsson K, Bjorkstrand B, Ljungman P: Faster engraftment but no reduction in infectious complications after peripheral blood stem cell transplantation compared to autologous bone marrow transplantation. Support Care Cancer 1998, 6:378–383.PubMedCrossRefGoogle Scholar
  23. 23.
    Kroger N, Zeller W, Hassan HT, et al.: Successful mobilization of peripheral blood stem cells in heavily pretreated myeloma patients with G-CSF alone. Ann Hematol 1998, 76:257–262.PubMedCrossRefGoogle Scholar
  24. 24.
    Gazitt Y, Tian E, Barlogie B, et al.: Differential mobilization of myeloma cells and normal hematopoietic stem cells in multiple myeloma after treatment with cyclophosphamide and granulocyte-macrophage colony-stimulating factor. Blood 1996, 87:805–811.PubMedGoogle Scholar
  25. 25.
    Goldschmidt H, Hegenbart U, Haas R, Hunstein W: Mobilization of peripheral blood progenitor cells with high-dose cyclophosphamide (4 or 7 g/m 2 ) and granulocyte colony-stimulating factor in patients with multiple myeloma. Bone Marrow Transplant 1996, 17:691–697.PubMedGoogle Scholar
  26. 26.
    Fitoussi O, Perreau V, Boiron JM, et al.: A comparison of toxicity following two different doses of cyclophosphamide for mobilization of peripheral blood progenitor cells in 116 multiple myeloma patients. Bone Marrow Transplant 2001, 27:837–842.PubMedCrossRefGoogle Scholar
  27. 27.
    Corso A, Arcaini L, Caberlon S, et al.: A combination of dexamethasone, cyclophosphamide, etoposide, and cisplatin is less toxic and more effective than high-dose cyclophosphamide for peripheral stem cell mobilization in multiple myeloma. Haematologica 2002, 87:1041–1045.PubMedGoogle Scholar
  28. 28.
    Arora M, Burns LJ, Barker JN, et al.: Randomized comparison of granulocyte colony-stimulating factor versus granulocyte-macrophage colony-stimulating factor plus intensive chemotherapy for peripheral blood stem cell mobilization and autologous transplantation in multiple myeloma. Biol Blood Marrow Transplant 2004, 10:395–404.PubMedCrossRefGoogle Scholar
  29. 29.
    Alegre A, Tomas JF, Martinez-Chamorro C, et al.: Comparison of peripheral blood progenitor cell mobilization in patients with multiple myeloma: high-dose cyclophosphamide plus GM-CSF vs G-CSF alone. Bone Marrow Transplant 1997, 20:211–217.PubMedCrossRefGoogle Scholar
  30. 30.
    Cremer FW, Kiel K, Wallmeier M, et al.: Leukapheresis products in multiple myeloma: lower tumor load after mobilization with cyclophosphamide plus granulocyte colony-stimulating factor (G-CSF) compared with G-CSF alone. Exp Hematol 1998, 26:969–975.PubMedGoogle Scholar
  31. 31.
    Bruns I, Steidl U, Kronenwett R, et al.: A single dose of 6 or 12 mg of pegfilgrastim for peripheral blood progenitor cell mobilization results in similar yields of CD34+ progenitors in patients with multiple myeloma. Transfusion 2006, 46:180–185.PubMedCrossRefGoogle Scholar
  32. 32.
    Stewart AK, Vescio R, Schiller G, et al.: Purging of autologous peripheral-blood stem cells using CD34 selection does not improve overall or progression-free survival after high-dose chemotherapy for multiple myeloma: results of a multicenter randomized controlled trial. J. Clin Oncol 2001, 19:3771–3779.PubMedGoogle Scholar
  33. 33.
    Goldschmidt H, Bouko Y, Bourhis JH, et al.: CD34+ selected PBPCT results in an increased infective risk without prolongation of event free survival in newly diagnosed myeloma: a randomised study from the EBMT [abstract]. Blood 2000, 96:558a.Google Scholar
  34. 34.
    Moreau P, Facon T, Attal M, et al.: Comparison of 200 mg/m(2) melphalan and 8 Gy total body irradiation plus 140 mg/m(2) melphalan as conditioning regimens for peripheral blood stem cell transplantation in patients with newly diagnosed multiple myeloma: final analysis of the Intergroupe Francophone du Myelome 9502 randomized trial. Blood 2002, 99:731–735.PubMedCrossRefGoogle Scholar
  35. 35.
    Barlogie B, Jagannath S, Desikan KR, et al.: Total therapy with tandem transplants for newly diagnosed multiple myeloma. Blood 1999, 93:55–65.PubMedGoogle Scholar
  36. 36.
    Attal M, Harousseau JL, Facon T, et al.: InterGroupe Francophone du Myelome: Single versus double autologous stem-cell transplantation for multiple myeloma. N Engl J Med 2003, 349:2495–2502.PubMedCrossRefGoogle Scholar
  37. 37.
    Cavo M, Cellini C, Zamagni E, et al.: Superiority of double over single autologous stem cell transplantation as first-line therapy for multiple myeloma [abstract]. Blood 2004, 104:155a (Abstract 536).Google Scholar
  38. 38.
    Tricot G, Jagannath S, Vesole DH, et al.: Relapse of multiple myeloma after autologous transplantation: survival after salvage therapy. Bone Marrow Transplant 1995, 16:7–11.PubMedGoogle Scholar
  39. 39.
    Alvares CL, Davies FE, Horton C, et al.: The role of second autografts in the management of myeloma at first relapse. Haematologica 2006, 91:141–142.PubMedGoogle Scholar
  40. 40.
    Elice F, Raimondi R, Tosetto A, et al.: Prolonged overall survival with second on-demand autologous transplant in multiple myeloma. Am J Hematol 2006, 81:426–431.PubMedCrossRefGoogle Scholar
  41. 41.
    Morris C, Iacobelli S, Brand R, et al.: Benefit and timing of second transplantations in multiple myeloma: clinical findings and methodological limitations in a European Group for Blood and Marrow Transplantation registry study. J Clin Oncol 2004, 22:1674–1681.PubMedCrossRefGoogle Scholar
  42. 42.
    Cunningham D, Powles R, Malpas J, et al.: A randomized trial of maintenance interferon following high-dose chemotherapy in multiple myeloma: long-term follow-up results. Br J Haematol 1998, 102:495–502.PubMedCrossRefGoogle Scholar
  43. 43.
    Attal M, Harousseau JL, Leyvraz S, et al.; for the Inter-Groupe Francophone du Myélome (IFM): Maintenance therapy with thalidomide improves survival in patients with multiple myeloma. Blood 2006, 108:3289–3294.PubMedCrossRefGoogle Scholar
  44. 44.
    Stewart AK, Chen CI, Howson-Jan K, et al.: Results of a multicenter randomized phase II trial of thalidomide and prednisone maintenance therapy for multiple myeloma after autologous stem cell transplant. Clin Cancer Res 2004, 10:8170–8176.PubMedCrossRefGoogle Scholar
  45. 45.
    Sahebi F, Spielberger R, Kogut NM, et al.: Maintenance thalidomide following single cycle autologous peripheral blood stem cell transplant in patients with multiple myeloma. Bone Marrow Transplant 2006, 37:825–829.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2007

Authors and Affiliations

  1. 1.Division of HematologyMayo ClinicRochesterUSA

Personalised recommendations