Autologous bone marrow transplantation for multiple myeloma.

Division of Hematology/Oncology, University of Arkansas for Medical Sciences, Little Rock.
Hematology/Oncology Clinics of North America (Impact Factor: 2.07). 05/1992; 6(2):437-49.
Source: PubMed

ABSTRACT Intensive cytotoxic chemotherapy is capable of more marked tumor cytoreduction including true complete remissions in multiple myeloma. Use of autologous marrow and blood stem cells as well as growth factors has reduced the risk of infection and severe extramedullary toxicities.

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    ABSTRACT: Multiple myeloma is a disease characterized by the increase of plasma cells and abnormal production of immunoglobulins properly in bone mellow and sporadicaly in other organs and systems. In this case report, an outpatient addressing to the family medicine policlinic of Ordu University Education and Research Hospital, with joint pains, fever, cough, weakness and loss of weight is narrated. By courtesy of this case, the addressing of patients with several diseases to the Family Medicine policlinics is emphasized.
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    ABSTRACT: Multiple myeloma is a relatively common B cell neoplasm seen more frequently in older patients. Most patients require treatment at the time of diagnosis; however, asymptomatic patients with good prognostic factors may be safely observed, sometimes for extended periods, without chemotherapy. Several recently developed prognostic factors, in particular β2-microglobulin, have improved our ability to predict clinical outcome. Traditional chemotherapy with intermittent oral melphalan plus prednisone can induce remissions in approximately 50% of patients. More aggressive multi-agent combination chemotherapy regimens can produce higher response rates compared with oral melphalan/prednisone, but whether this results in a survival benefit remains controversial. All patients treated with conventional dose chemotherapy will eventually relapse. Maintenance therapy with interferon-α can prolong the duration of remissions. Relapse is associated with more aggressive, less responsive, disease. Conventional salvage therapies are effective in the minority of patients, and responses are short lived. High dose chemotherapy, with or without total body irradiation, followed by autologous bone marrow or peripheral stem cell transplantation can induce remissions in some patients who have relapsed or whose disease is refractory to conventional salvage chemotherapy. Unfortunately, these responses are usually not durable. The results of autologous transplantation in a more favourable group of previously untreated or minimally treated patients have been encouraging. Increased response rates, more durable remissions and, probably, improved survival compared with conventional dose chemotherapy have been demonstrated. Further study is needed to determine if autologous transplantation will cure patients with myeloma. Allogeneic bone marrow transplantation, although of limited applicability and associated with high treatment-related mortality, has the greatest potential to provide patients with long term survival.
    11/1995; 4(5). DOI:10.1007/BF03259298
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    ABSTRACT: Eighteen French centers reported 133 autologous stem cell transplantations performed after first remission induction in multiple myeloma. The source of stem cell was marrow (81 cases), blood (51 cases) or marrow plus blood (1 case). The immediate outcome after transplantation was 49 (37%) complete remissions (CR; 13 maintained, 36 achieved), 61 (46%) partial remissions, 17 failures and 5 toxic deaths. With a median follow up of 35 months, the median remission duration was 33 months, the median time to treatment failure was 22 months. The median overall survival was 46 months, 54 months for the 103 patients responding to primary treatment and 30 months for the 30 nonresponders. In univariate analysis, the outcome was influenced by age, Ig isotype, initial β2-Microglobulin level, response to initial chemotherapy, plasma cell marrow involvement at the time of harvest, albumin and β2-Microglobulin level at the time of transplantation and CR achievement after transplantation. In multivariate analysis, the most important prognostic factor was the quality of response after transplantation.The conditioning regimen and the source of stem cell had no significant impact on immediate and long-term results. Maintenance therapy with a interferon did not appear to prolong remission duration or survival.Autologous stem cell transplantation is an effective consolidation for patients responding to primary treatment and a salvage therapy for some nonresponding patients. This approach has to be compared to conventional chemotherapy in prospective randomized studies. The critical impact of CR achievement on survival implies new strategies in order to increase the CR rate.
    Stem Cells 08/1996; 13(S2). DOI:10.1002/stem.5530130721 · 7.70 Impact Factor