The role of cytotoxic therapy with hematopoietic stem cell transplantation in the therapy of multiple myeloma: an evidence-based review.
We report the results of a consecutive series of patients who underwent autologous (auto) (40), allogeneic (allo) (22) or syngeneic transplantation (2) for multiple myeloma (MM) at our centre. Median age at diagnosis was 45.5 (auto) and 43 (allo) years. Most patients had stage 2 (27% auto; 27% allo) or stage 3 (62% auto; 50% allo) disease and 73% demonstrated chemosensitivity prior to transplant. Median time from diagnosis to transplant was 18.6 months (auto) and 16.4 months (allo). Standard conditioning regimens were used. Median time to neutrophil engraftment was 11 days (7–18) (auto) and 18 days (13–24) (allo) and median time to platelet engraftment was 11 days (6–60) and 18 days (13–105), respectively. Ninety-day mortality was 5% (auto) and 27% (allo). Median follow-up was 15 months (6–48) (auto) and 42 months (24–52) (allo). Three-year progression-free survival (PFS) was 17 ± 10% (auto) and 22 ± 9% (allo) and 3-year overall survival (OS) was 74 ± 11% (auto) and 32 ± 10% (allo). Autologous transplantation for MM is a safe procedure with good OS although disease progression following transplant is frequent. Allogeneic transplantation has a high procedure-related mortality and PFS comparable to autologous transplantation but OS is poor. The early mortality and high OS of autologous transplantation in MM compares favourably with both the results of allogeneic transplantation and published results of standard therapy in this retrospective analysis.