Hematopoietic Stem Cell Transplantation in Multiple Myeloma in the Era of Novel Therapies

Al-Anazi, Khalid Ahmed

doi:10.5772/intechopen.79999

Cited by 6 publications

(5 citation statements)

References 197 publications

(290 reference statements)

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“…In case of refractory disease, most patients require a triplet regimen at relapse, with the choice of regimen varying with each successive relapse [1,3]. The old, current, and future therapeutic modalities in MM are shown in [14][15][16][17][18][19] treatment; (8) advanced disease, stage III; and ( 9) frailty [16,20]. In patients with HR-MM (double-hit or triple-hit myeloma), it is recommended to adopt the following line of treatment, induction therapy with 3-4 cycles of VRd followed by autologous HSCT, and then maintenance therapy with bortezomib-based regimen, that is, bortezomib every 2 weeks or low-intensity VRd regimen till disease progression [1,[20][21][22][23].…”

Section: General Treatment Outlinementioning

confidence: 99%

Multiple Myeloma in the Era of Novel Agents and Stem Cell Therapies

Al-Anazi¹

2023

Recent Updates on Multiple Myeloma

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The recent availability of several lines of novel therapeutic agents such as immunomodulatory agents, proteasome inhibitors, and monoclonal antibodies; the widespread utilization of hematopoietic stem cell transplantation; the use of advanced diagnostic techniques that allow risk stratification and monitoring of treatment responses; and the general improvement in health care have revolutionized treatment of patients with multiple myeloma and this has translated into significant improvements in survival outcomes. Monitoring of minimal residual disease can guide the intensity of treatment, and the efficient application of modern diagnostic tools in monitoring treatment responses in real-world clinical practice can hopefully be achieved in the near future. The recent use of quadruplet regimens in the treatment of patients with multiple myeloma has translated into unprecedented treatment responses and survival outcomes. Also, chimeric antigen receptor T-cell therapy and bispecific antibodies represent a new dimension in the precision medicine in MM. Additionally, our ability to induce deep responses has improved, and the treatment goal in myeloma patients tolerating the recommended therapy has moved from delay of disease progression to induction of the deepest possible response.

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Section: General Treatment Outlinementioning

confidence: 99%

Multiple Myeloma in the Era of Novel Agents and Stem Cell Therapies

Al-Anazi¹

2023

Recent Updates on Multiple Myeloma

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“…Hematopoietic stem cell transplantation (HSCT) is a clinical procedure involving the infusion of healthy donor multipotent hematopoietic stem cells (HSCs) to correct a patient's damaged/ defective bone marrow/immune system and consequently reestablish a normal hematopoietic function (16,17). It is a standard course of treatment for a variety of fatal malignant and non-malignant blood disorders such as leukemias, severe aplastic anemia, multiple myeloma, immune deficiency disorders, and lymphomas (18)(19)(20)(21)(22)(23)(24). Broadly speaking, HSCT has three clinicaluse cases.…”

Section: Hematopoietic Stem Cell Transplantationmentioning

confidence: 99%

The Impact of Human Microbiotas in Hematopoietic Stem Cell and Organ Transplantation

Sen

Thummer

2022

Front. Immunol.

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The human microbiota heavily influences most vital aspects of human physiology including organ transplantation outcomes and transplant rejection risk. A variety of organ transplantation scenarios such as lung and heart transplantation as well as hematopoietic stem cell transplantation is heavily influenced by the human microbiotas. The human microbiota refers to a rich, diverse, and complex ecosystem of bacteria, fungi, archaea, helminths, protozoans, parasites, and viruses. Research accumulating over the past decade has established the existence of complex cross-species, cross-kingdom interactions between the residents of the various human microbiotas and the human body. Since the gut microbiota is the densest, most popular, and most studied human microbiota, the impact of other human microbiotas such as the oral, lung, urinary, and genital microbiotas is often overshadowed. However, these microbiotas also provide critical and unique insights pertaining to transplantation success, rejection risk, and overall host health, across multiple different transplantation scenarios. Organ transplantation as well as the pre-, peri-, and post-transplant pharmacological regimens patients undergo is known to adversely impact the microbiotas, thereby increasing the risk of adverse patient outcomes. Over the past decade, holistic approaches to post-transplant patient care such as the administration of clinical and dietary interventions aiming at restoring deranged microbiota community structures have been gaining momentum. Examples of these include prebiotic and probiotic administration, fecal microbial transplantation, and bacteriophage-mediated multidrug-resistant bacterial decolonization. This review will discuss these perspectives and explore the role of different human microbiotas in the context of various transplantation scenarios.

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“…Autologous HSCT is still considered the standard of care in the treatment of patients with MM who are eligible for transplantation [5,[17][18][19][20]. The standard conditioning regimen for patients with MM undergoing autologous HSCT is highdose (HD) melphalan but in patients with renal dysfunction or failure, reductions in melphalan doses according to creatinine clearance are required [4,5,[17][18][19]. Cryopreservation of the harvested stem cells is routinely employed prior to autologous HSCT [17,20,21].…”

Section: Introductionmentioning

confidence: 99%

“…The standard conditioning regimen for patients with MM undergoing autologous HSCT is highdose (HD) melphalan but in patients with renal dysfunction or failure, reductions in melphalan doses according to creatinine clearance are required [4,5,[17][18][19]. Cryopreservation of the harvested stem cells is routinely employed prior to autologous HSCT [17,20,21]. However, autologous HSCT using non-cryopreserved stem cells has been shown to be safe and cost-effective and leads to short-term and longterm results that are at least equivalent to autologous HSCT using cryopreserved stem cells [17,[21][22][23].…”

Section: Introductionmentioning

confidence: 99%

“…Cryopreservation of the harvested stem cells is routinely employed prior to autologous HSCT [17,20,21]. However, autologous HSCT using non-cryopreserved stem cells has been shown to be safe and cost-effective and leads to short-term and longterm results that are at least equivalent to autologous HSCT using cryopreserved stem cells [17,[21][22][23]. Patients with MM are ideal candidates for outpatient autologous HSCT due to the ease of administration of HD melphalan, the relatively low…”

Section: Introductionmentioning

confidence: 99%

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Introductory Chapter: Update on Multiple Myeloma

Al-Anazi¹

2023

Recent Updates on Multiple Myeloma

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extra-hematological toxicity, and the brief period of neutropenia [24,25]. Outpatient HSCT has certain inclusion criteria and exclusion criteria as well as several advantages that include: significant reduction in costs; saving hospital beds; lower rate of infections; and lower morbidity and treatment-related mortality [24,[26][27][28].In patients with MM, maintenance therapy after autologous HSCT has been shown to deepen and prolong responses and increase OS and progression-free survival (PFS) [29]. Lenalidomide maintenance given after autologous HSCT till disease progression is the standard of care in patients with SR MM while bortezomib maintenance therapy after autologous HSCT is preferable in MM patients having: HR cytogenetics, renal insufficiency, inability to tolerate lenalidomide, and previous history of another cancer [30][31][32]. Continuous therapy has been shown to significantly improve OS and PFS [33,34]. Continuous therapy till disease progression has become a key strategy in the treatment of patients with MM as it has been shown to improve duration of remission and it represents the standard approach for patients with MM both at diagnosis and at relapse [35,36].Unfortunately, nearly all MM patients ultimately relapse, even those who experience a complete response (CR) to initial therapy [19]. Management of the relapsed disease remains a critical aspect of MM care and an important area of ongoing research [19]. New treatment strategies and therapeutic modalities are needed to treat MM in relapse, particularly in case of triple-refractory disease [1]. Treatment of relapsed MM should depend on: the number of relapses encountered; the previous anti-myeloma treatment; the presence of de novo or acquired drug resistance; aggressiveness of disease relapse particularly in case of extramedullary disease, plasma cell leukemia, or clonal evolution [3,37].Minimal residual disease (MRD) is an important factor that can independently predict the prognosis of MM during treatment as undetectable MRD has been shown to improve PFS and OS regardless: disease status, prior transplant, or cytogenetic risk [38]. Flow cytometry has become a valuable tool to monitor MRD and evaluate the depth of CR. However, next-generation flow cytometry is more sensitive than the standard flow cytometry in detecting MRD in patients with MM [39]. Finally, the development of novel targeting therapies with different mechanisms of action is needed to achieve deep and durable responses in an attempt to cure MM while identification of tumor intrinsic and extrinsic resistance mechanisms may direct the design of combinations of novel drugs that prevent or overcome drug resistance so as to improve patient survival [40,41].

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Hematopoietic Stem Cell Transplantation in Multiple Myeloma in the Era of Novel Therapies

Cited by 6 publications

References 197 publications

Multiple Myeloma in the Era of Novel Agents and Stem Cell Therapies

Multiple Myeloma in the Era of Novel Agents and Stem Cell Therapies

The Impact of Human Microbiotas in Hematopoietic Stem Cell and Organ Transplantation

Introductory Chapter: Update on Multiple Myeloma

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