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Ricciuti G, Falcone A, Cascavilla N, Martinelli G, Cerchione C. Autologous stem cell transplantation in multiple myeloma. Panminerva Med 2020; 62:220-224. [PMID: 32955179 DOI: 10.23736/s0031-0808.20.04114-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The treatment of patients with multiple myeloma has changed in the last decades, with an improved median survival of 8-10 years. The current treatment for newly diagnosed multiple myeloma patients eligible for autologous transplantation consists of 4 phases: pretransplant, induction, transplant, post-transplant consolidation and maintenance. Even today, a long-term disease control is the goal of multiple myeloma treatment in current clinical practice. In this review we discuss the role of autologous stem cell transplantation in multiple myeloma, the eligibility of patients for transplantation and the usefulness of an upfront tandem transplantation. The assessment of frailty and significant comorbidities plays an important role in determining transplant eligibility. Careful patient selection based on overall health status is crucial to ensure a balance between risks and benefits. In the era of induction regimens with new agents, upfront autologous transplantation remains the standard of care for young patients with newly diagnosed multiple myeloma due to the longer progression-free survival showed in randomized clinical studies. With the currently available data, the tandem transplantation in multiple myeloma may be considered in patients with high-risk cytogenetics, in particular, those who did not receive a new triplet combination or those with a lower response than very good partial response following their first transplantation.
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Affiliation(s)
- Giuseppina Ricciuti
- Department of Hematology and Bone Marrow Transplant, IRCCS Casa Sollievo della Sofferenza Hospital Foundation, San Giovanni Rotondo, Foggia, Italy -
| | - Antonietta Falcone
- Department of Hematology and Bone Marrow Transplant, IRCCS Casa Sollievo della Sofferenza Hospital Foundation, San Giovanni Rotondo, Foggia, Italy
| | - Nicola Cascavilla
- Department of Hematology and Bone Marrow Transplant, IRCCS Casa Sollievo della Sofferenza Hospital Foundation, San Giovanni Rotondo, Foggia, Italy
| | - Giovanni Martinelli
- Department of Hematology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
| | - Claudio Cerchione
- Department of Hematology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
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Goede V. [Multiple myeloma in old people : Practical skills for geriatricians and general practitioners]. Z Gerontol Geriatr 2020; 53:263-272. [PMID: 32130502 DOI: 10.1007/s00391-020-01701-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 11/20/2019] [Indexed: 11/26/2022]
Abstract
Multiple myeloma is an age-associated disease. In aged and multimorbid patients the diagnosis could be delayed due to the diversity of symptoms of this disease. Key diagnostic steps are the detection of an M protein as a surrogate of clonal plasma cell proliferation and evaluation of the CRAB criteria (hypercalcemia, renal insufficiency, anemia, bone lesions). The individual prognosis and vulnerability to treatment complications can be assessed by use of validated scores. Following the introduction of many new drugs, vulnerable aged patients with multiple myeloma can also be very effectively treated with modern (partially chemotherapy-free) combination treatment and additional supportive care. Successful management of aged and multimorbid patients with multiple myeloma is not the sole task of the treating hemato-oncologist but also mostly requires the inclusion of general practitioners and geriatricians.
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Affiliation(s)
- Valentin Goede
- Sektion für Onkologische Geriatrie, St. Marien-Hospital, Kunibertskloster 11-13, 50668, Köln, Deutschland.
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Abstract
PURPOSE OF REVIEW Autologous stem cell transplantation has been the standard of care in myeloma treatment for many years, but the availability of newer antimyeloma drugs and the emerging data from chimeric antigen receptor (CAR) T-cell clinical studies make us question the relevance of it. The purpose of this review is to go over recent data and to reassess the current status of autologous stem cell transplantation as a standard of care. RECENT FINDINGS Autologous stem cell transplantation can be safely performed for elderly patients and there is no absolute age limit. Recent data on BEAM (Carmustine, Etoposide, Cytarabine, and Melphalan), Busulfan/Melphalan, and Carmustine/Melphalan conditioning when compared with Melphalan showed favorable survival outcomes with manageable toxicities although we need to see data from randomized, multicenter studies. Posttransplant maintenance and consolidation can maximize the benefit of transplant by prolonging progression-free survival. Current B-cell maturation antigen CAR T-cell therapy showed remarkably high response rates, but didn't seem to provide durable response yet. SUMMARY Recent advances in myeloma therapy and autologous stem cell transplantation are described. Although we've seen many new developments including CAR T-cell therapies, autologous stem cell transplantation remains as the standard of care. However, it may be replaced by or combined with newer therapies in the future.
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Bashir Q, Chamoun K, Milton DR, Khan M, Ahmed S, Mehta R, Popat UR, Kebriaei P, Nieto Y, Oran B, Ciurea SO, Hosing C, Khouri I, Patel K, Manasanch EE, Lee HC, Orlowski RZ, Champlin RE, Qazilbash MH. Outcomes of autologous hematopoietic cell transplantation in myeloma patients aged ≥75 years. Leuk Lymphoma 2019; 60:3536-3543. [DOI: 10.1080/10428194.2019.1633633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Qaiser Bashir
- Department of Stem Cell Transplantation and Cellular Therapy, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Kamal Chamoun
- Department of Stem Cell Transplantation and Cellular Therapy, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Denái R. Milton
- Department of Biostatistics, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Maliha Khan
- Department of Stem Cell Transplantation and Cellular Therapy, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Sairah Ahmed
- Department of Stem Cell Transplantation and Cellular Therapy, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Rohtesh Mehta
- Department of Stem Cell Transplantation and Cellular Therapy, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Uday R. Popat
- Department of Stem Cell Transplantation and Cellular Therapy, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Yago Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Betul Oran
- Department of Stem Cell Transplantation and Cellular Therapy, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Stefan O. Ciurea
- Department of Stem Cell Transplantation and Cellular Therapy, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Chitra Hosing
- Department of Stem Cell Transplantation and Cellular Therapy, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Isa Khouri
- Department of Stem Cell Transplantation and Cellular Therapy, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Krina Patel
- Department of Lymphoma and Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Hans C. Lee
- Department of Lymphoma and Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - Robert Z. Orlowski
- Department of Lymphoma and Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - Richard E. Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Muzaffar H. Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, UT MD Anderson Cancer Center, Houston, TX, USA
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