Hematopoietic Cell Transplantation for Multiple Myeloma

Bensinger, William I.

doi:10.1177/107327489800500304

Cited by 8 publications

(2 citation statements)

References 49 publications

(58 reference statements)

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“…The most commonly used regimens at the Fred Hutchinson Cancer Research Center (FHCRC) and the City of Hope have been described elsewhere. 2 Techniques of GVHD and microbial prophylaxis have changed over the 27 years encompassed by this report. [3][4][5] Patients are followed by our respective centers to day 100 and then by their local physicians.…”

Section: Techniques Of Hematopoietic Cell Transplantationmentioning

confidence: 99%

Biliary obstruction in hematopoietic cell transplant recipients: an uncommon diagnosis with specific causes

Murakami

Louie

Chan

et al. 1999

Bone Marrow Transplant

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Summary:Jaundice is a common problem in marrow transplant recipients. The incidence of bile duct obstruction in this setting is unknown. The purpose of this study was to determine the incidence of biliary obstruction, the causes, and outcomes following marrow transplant. Consecutive cases were reviewed at two major transplant centers in the United States from 1969 to 1996 at the Fred Hutchinson Cancer Research Center and 1989 to 1996 at the City of Hope National Medical Center. Nine cases of biliary obstruction were identified as a cause of jaundice in 7412 marrow transplant recipients, an incidence of 0.12%. The presentation was bimodal, with seven cases occurring prior to day 100 and two occurring 2 to 4 years after transplantation. The age distribution was 15 to 50 years and all patients had received allogeneic transplants. The causes of obstruction included gallbladder sludge (n‫,)1؍‬ a duodenal hematoma (n‫,)1؍‬ choledocholithiasis with biliary pancreatitis (n‫,)1؍‬ bile duct infection (n‫,)2؍‬ recurrent malignancy (n‫,)1؍‬ choledocholithiasis associated with a benign stricture (n‫,)1؍‬ Epstein-Barr virus-related lymphoproliferative disorder (n‫,)1؍‬ and a benign stricture of unknown etiology (n‫.)1؍‬ Biliary obstruction is a rare cause of jaundice in the post-transplant period. The presentation was similar to that of other post-transplant hepatobiliary problems, but with disparate causes.

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Section: Techniques Of Hematopoietic Cell Transplantationmentioning

confidence: 99%

Biliary obstruction in hematopoietic cell transplant recipients: an uncommon diagnosis with specific causes

Murakami

Louie

Chan

et al. 1999

Bone Marrow Transplant

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“…High-dose chemotherapy with autologous stem cell transplantation (ASCT) can result in prolonged survival, 7 but unfortunately, few, if any, patients with MM who receive ASCT are cured. 8 Only allo-SCT is curative in MM. However, the very high transplant-related morbidity and mortality limit the application of allo-SCT to younger patients.…”

mentioning

confidence: 99%

Enhanced graft-versus-tumor effect following dose-reduced conditioning and allogeneic transplantation for refractory lymphoid malignancies after high-dose therapy

Mohty

Fégueux

Exbrayat

et al. 2001

Bone Marrow Transplant

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Summary:Non-myeloablative regimens have been proven to allow engraftment following allogeneic stem cells transplantation (allo-SCT) with minimal procedure-related toxicity. Conventional allo-SCT may produce remissions in patients with relapsed and refractory lymphoid malignancies (LM) but these good results may be achieved at the cost of high treatment-related morbidity and mortality. Application of allo-SCT using less intensive regimens may temper the frequency of these complications, allowing a potent graft-versus-tumor effect (GVT). We present our data on 11 patients with LM receiving allo-SCT with a reduced regimen. Ten patients had received previous high-dose therapy, and were at high risk for toxicity, thus precluding the use of allo-SCT. A fludarabine and low-dose busulfan combination facilitated engraftment while exerting GVT. Hematological recovery was quick, and full donor T cell chimerism preceded acute GVHD. GVHD and infections were the major problems. Spontaneous acute GVHD occurred in eight patients (72%). Five patients (45%) achieved complete remission, and the GVT effect was closely associated with GVHD. These results support the concept that GVT is effective against LM in patients who have been heavily pretreated. Further studies are needed to investigate strategies to generate more specific alloreactive effects providing optimal GVT and an acceptable risk of GVHD and infections. Bone Marrow Transplantation the alloreactivity against host tumor cells. 1,2 Non-myeloablative and reduced conditioning regimens have recently been proven to allow engraftment following allo-SCT with minimal procedure-related toxicity in patients with advanced disease. 3 The immune reaction between donorderived immunocompetent T lymphocytes and host-type tumor cells has been well established to be the major antitumor agent in allo-SCT. 1 Evidence supporting the socalled graft-versus-tumor (GVT) effect includes the higher risk of relapse following T cell-depleted or syngeneic transplantation. 4,5 Furthermore, donor lymphocyte infusions (DLI) may re-induce remission in many patients relapsing after allo-SCT. 6 New approaches using non-myeloablative and reduced conditioning regimens aim to extend the use of allo-SCT to patients who are ineligible for high-dose chemotherapy or total body irradiation by prioritizing and increasing the immunosuppressive aspect of the preparation.Multiple myeloma (MM) is a lymphoid malignancy (LM) with a median survival of 3 years. Despite the development of numerous conventional chemotherapy regimens, there has been little progress in improving the survival of patients with MM. High-dose chemotherapy with autologous stem cell transplantation (ASCT) can result in prolonged survival, 7 but unfortunately, few, if any, patients with MM who receive ASCT are cured. 8 Only allo-SCT is curative in MM. However, the very high transplant-related morbidity and mortality limit the application of allo-SCT to younger patients. Allo-SCT has also produced prolonged remissions in patients with relapsed and ref...

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Allogeneic stem cell transplantation after reduced-intensity conditioning in lymphoid malignancies

Sureda

Schmitz

2003

Ann Hematol

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Allogeneic stem cell transplantation (allo-SCT) is an effective therapeutic option for a wide range of hematological malignancies. The toxicity of the conditioning regimen and graft-versus-host disease (GVHD) occurring after the infusion of the graft remain the most important factors leading to high morbidity and mortality. Reduced-intensity conditioning regimens have recently been developed in an effort to reduce the toxicity associated with conventional allo-SCT while preserving the curative potential of the graft-versus-tumor (GVT) effect. Most patients with lymphoproliferative disorders are not ideal candidates for allo-SCT due to higher age at diagnosis, which together with the advanced stage of disease at the time of transplantation can lead to a high transplant-related mortality (TRM). Preliminary experience indicates that reduced-intensity allo-SCT is feasible in such patients. The immediate TRM is low in comparison with conventional procedures and overall results seem promising, thus indicating the existence of a GVT effect. Nevertheless, all series are still low in numbers and follow-up is too short to draw definitive conclusions. Acute and chronic GVHD remain a significant problem with incidences comparable to the conventional setting in some series. Thus, therapeutic strategies must be sought to decrease GVHD without abrogating the GVT effect.

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Hematopoietic Cell Transplantation for Multiple Myeloma

Cited by 8 publications

References 49 publications

Biliary obstruction in hematopoietic cell transplant recipients: an uncommon diagnosis with specific causes

Biliary obstruction in hematopoietic cell transplant recipients: an uncommon diagnosis with specific causes

Enhanced graft-versus-tumor effect following dose-reduced conditioning and allogeneic transplantation for refractory lymphoid malignancies after high-dose therapy

Allogeneic stem cell transplantation after reduced-intensity conditioning in lymphoid malignancies

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