Abstract
Multiple myeloma (MM) is an indolent B-cell malignancy, where treatment is aimed at preventing organ dysfunction from light chain accumulation (slowing disease progression) and inducing remission. Allogeneic stem cell transplant (allo-SCT), through graft versus myeloma (GVM) effects, has the potential to induce remission to a potentially curative-like state. In this systematic review, we aimed to understand this relationship to the risks and severity of disease in categorized patients and gain an updated comprehension of the future of allo-SCT in MM treatment. We conducted this review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched the PubMed database to obtain the specified literature with both the use of keywords and Medical Subject Headings (MeSH). A total of 16 relevant articles were included for discussion after the quality appraisal was completed, as appropriate, by either the Cochrane tool or Newcastle-Ottawa checklist. Our review concludes that while allo-SCT may benefit high-risk patients, successful procedures may incorporate a tandem autologous hematopoietic stem cell transplant approach in combination with novel pharmacologic contributions for which there is an observed synergy in the modulation of the immunologic microenvironment. Furthermore, tailored patient selection by evaluating pre-transplant factors including high-risk cytogenetics, age, and pre-salvage International Staging System (ISS) can predict post-transplantation success including non-relapse mortality. Successive research should continue to revise and update treatment options as the evolving therapeutic drug regimens may change over the course of indolent disease.
Highlights
BackgroundMultiple myeloma (MM) affects five in every 100,000 people yearly [1] and makes up about 10% of all hematological cancers overall [1,2]
It is an indolent B-cell malignancy involving long-lived plasma cells, which remain in the bone marrow and produce antigen-specific immunoglobulin; malignant plasma cell clones produce an excess of light chains, which contribute to the pathology of the disease in addition to restraining the intended immune defense [3]
A small prospective study by Van Elssen et al assessed if killer cell immunoglobulin-like receptor (KIR)-ligand mismatched haploidentical bone marrow transplant (BMT) combined with post-transplant cyclophosphamide (PTCy) improves survival in poor-risk chemoresistant MM, which, in this study, was not superior to conventional allo-high-dose pharmacotherapy with autohematopoietic cell transplant (HCT) [25]
Summary
Multiple myeloma (MM) affects five in every 100,000 people yearly [1] and makes up about 10% of all hematological cancers overall [1,2]. It is an indolent B-cell malignancy involving long-lived plasma cells, which remain in the bone marrow and produce antigen-specific immunoglobulin; malignant plasma cell clones produce an excess of light chains, which contribute to the pathology of the disease in addition to restraining the intended immune defense [3]. MGUS, affecting roughly 3% of people over the age of 50 years, converts to MM or a comparable malignancy yearly at about 1% [6]. Average survival has improved, post-diagnosis life expectancy remains around 7-10 years, making MM an incurable malignancy to this day [8]
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