06 December 2003
High intensity regimens with autologous hematopoietic stem cell transplantation as treatment of multiple myeloma.Abdulnaser Awedan
Ann Transplant 2002; 7(2): 38-43 :: ID: 5550
The treatment of multiple myeloma still remains under investigation. Conventional chemotherapy with currently used agents (i.e., Melphalan) effects complete remission in no more than 5% of patients. High dose chemotherapy followed by hematopoietic stem cells transplantation results in complete remission rates between 25% and 75% and a 3-year probability of event-free survival between 40% and 60% but is not curative since most patients relapse after 1.5 to 3 years. Therefore, it becomes the treatment of choice for multiple myeloma. The drugs used in high dose therapy include: high dose melphalan (200 mg/m2) as single agent., melphalan (140 mg/m2) and total body irradiation (TBI), Busulfan and melphalan... etc. The use of the peripheral blood stem cell transplantation has allowed a reduction in the toxicity of high-dose regimens, but has not led to an increase in the overall response rate or survival. Hematopoietic stem cells from peripheral blood are preferred for transplantation because they restore hematopoiesis more rapidly than do bone marrow cells and the numbers of tumor cells are lower in peripheral blood than bone marrow cells. Peripheral blood stem cell transplantation was associated with significant reduction in the duration of aplasia and transfusion requirements. Several regimens have been proposed for stem cells mobilization including: High-dose cyclophosphamide and G or GM-CSF, G-CSF alone, and cyclophosphamide and etoposide with G-CSF... ect.. Further attempts to improve the results of autotransplantation have included intensification with tandem transplantations (double transplants) and reduction of tumor cells in stem cell infusion. The aim of this review is to summarize the current knowledge about the treatment of multiple myeloma with high dose chemotherapy with autologous hematopoietic stem cell transplantation.
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