Post-Autologous (ASCT) Stem Cell Transplant Therapy in Multiple Myeloma
Autologous stem cell transplant (ASCT) is the standard of care in transplant-eligible multiple myeloma patients and is associated with significant improvement in progression-free survival (PFS), complete remission rates (CR), and overall survival (OS). However, majority of patients eventually relaps...
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| Format: | Article |
| Language: | English |
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Wiley
2014-01-01
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| Series: | Advances in Hematology |
| Online Access: | http://dx.doi.org/10.1155/2014/652395 |
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| author | Zeina Al-Mansour Muthalagu Ramanathan |
| author_facet | Zeina Al-Mansour Muthalagu Ramanathan |
| author_sort | Zeina Al-Mansour |
| collection | DOAJ |
| description | Autologous stem cell transplant (ASCT) is the standard of care in transplant-eligible multiple myeloma patients and is associated with significant improvement in progression-free survival (PFS), complete remission rates (CR), and overall survival (OS). However, majority of patients eventually relapse, with a median PFS of around 36 months. Relapses are harder to treat and prognosis declines with each relapse. Achieving and maintaining “best response” to initial therapy is the ultimate goal of first-line treatment and sustained CR is a powerful surrogate for extended survival especially in high-risk multiple myeloma. ASCT is often followed by consolidation/maintenance phase to deepen and/or maintain the response achieved by induction and ASCT. Novel agents like thalidomide, lenalidomide, and bortezomib have been used as single agents or in combination. Thalidomide use has been associated with a meaningful improvement in PFS and EFS, however, with substantial side effects. Data with lenalidomide maintenance after-ASCT is favorable, but the optimal duration of lenalidomide maintenance is still unclear. Bortezomib use has been associated with superior outcomes, predominantly in high-risk myeloma patients. Combination regimens utilizing a proteasome inhibitor (i.e., bortezomib) with an immunomodulatory drug (thalidomide or lenalidomide) have provided the best outcomes. This review article serves as a review of the best available evidence in post-ASCT approaches in multiple myeloma. |
| format | Article |
| id | doaj-art-e7cbdfd4c61d4a6a84fa6b3b2009eb7a |
| institution | Kabale University |
| issn | 1687-9104 1687-9112 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
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| series | Advances in Hematology |
| spelling | doaj-art-e7cbdfd4c61d4a6a84fa6b3b2009eb7a2025-02-03T05:49:32ZengWileyAdvances in Hematology1687-91041687-91122014-01-01201410.1155/2014/652395652395Post-Autologous (ASCT) Stem Cell Transplant Therapy in Multiple MyelomaZeina Al-Mansour0Muthalagu Ramanathan1Division of Hematology/Oncology, School of Medicine, University of Massachusetts, 55 Lake Avenue North, Worcester, MA 01655, USADivision of Hematology/Oncology, School of Medicine, University of Massachusetts, 55 Lake Avenue North, Worcester, MA 01655, USAAutologous stem cell transplant (ASCT) is the standard of care in transplant-eligible multiple myeloma patients and is associated with significant improvement in progression-free survival (PFS), complete remission rates (CR), and overall survival (OS). However, majority of patients eventually relapse, with a median PFS of around 36 months. Relapses are harder to treat and prognosis declines with each relapse. Achieving and maintaining “best response” to initial therapy is the ultimate goal of first-line treatment and sustained CR is a powerful surrogate for extended survival especially in high-risk multiple myeloma. ASCT is often followed by consolidation/maintenance phase to deepen and/or maintain the response achieved by induction and ASCT. Novel agents like thalidomide, lenalidomide, and bortezomib have been used as single agents or in combination. Thalidomide use has been associated with a meaningful improvement in PFS and EFS, however, with substantial side effects. Data with lenalidomide maintenance after-ASCT is favorable, but the optimal duration of lenalidomide maintenance is still unclear. Bortezomib use has been associated with superior outcomes, predominantly in high-risk myeloma patients. Combination regimens utilizing a proteasome inhibitor (i.e., bortezomib) with an immunomodulatory drug (thalidomide or lenalidomide) have provided the best outcomes. This review article serves as a review of the best available evidence in post-ASCT approaches in multiple myeloma.http://dx.doi.org/10.1155/2014/652395 |
| spellingShingle | Zeina Al-Mansour Muthalagu Ramanathan Post-Autologous (ASCT) Stem Cell Transplant Therapy in Multiple Myeloma Advances in Hematology |
| title | Post-Autologous (ASCT) Stem Cell Transplant Therapy in Multiple Myeloma |
| title_full | Post-Autologous (ASCT) Stem Cell Transplant Therapy in Multiple Myeloma |
| title_fullStr | Post-Autologous (ASCT) Stem Cell Transplant Therapy in Multiple Myeloma |
| title_full_unstemmed | Post-Autologous (ASCT) Stem Cell Transplant Therapy in Multiple Myeloma |
| title_short | Post-Autologous (ASCT) Stem Cell Transplant Therapy in Multiple Myeloma |
| title_sort | post autologous asct stem cell transplant therapy in multiple myeloma |
| url | http://dx.doi.org/10.1155/2014/652395 |
| work_keys_str_mv | AT zeinaalmansour postautologousasctstemcelltransplanttherapyinmultiplemyeloma AT muthalaguramanathan postautologousasctstemcelltransplanttherapyinmultiplemyeloma |