82
significant differences in OS were noted between patients who underwent tandem
ASCT and ASCT/AlloSCT [ 65 ]. In contrary, long term results generated by the
EBMT nonmyeloablative allogeneic stem cell transplantation in MM (NMAM)
showed that PFS and OS were significantly favorable for patients who received
ASCT/RICAlloSCT compared to those who underwent tandem ASCT, with OS
and PFS rates at 96 months of 49% versus 36% (p = 0.03) and 22% versus 12%
(p = 0.027), respectively [ 66 ]. The corresponding progression and/or relapse rate
was significantly lower in RICAlloSCT (60%) compared to the tandem (82%)
group (p = 0.002), but with higher rate of 36month nonrelapse mortality rate of
13% and 3% (p = 0.0004%), respectively.
Despite promising data, it is general practice that AlloSCT in MM patients
should be performed in clinical trials to better define the role of salvage allogeneic
SCT after primary therapy. Furthermore the postallogeneic SCT maintenance ther
apy needs to be explored in prospective trials, and the role of salvage allogeneic
HCT in patients with MM relapsing after primary therapy needs to be defined [ 48 ].
5.6 Conclusion
The application of HDchemotherapy and ASCT is considered standard consolida
tion treatment in patients with MM. Although several novel antimyeloma agents
have been introduced in the last couple of years, HDchemotherapy and ASCT
remains an integral part and solid backbone in treatment of MM. Cure in MM can
be achieved in a large number of lowrisk patients by applying HDchemotherapy
and tandem ASCT in the setting of the Total Therapy approach. HDchemotherapy
and ASCT can be effectively used in refractory and relapsing myeloma patients, as
well as in selected elderly myeloma patients.
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S. Thanendrarajan and T.K. Garg