The changing role of high dose melphalan with stem cell rescue in the treatment of newly diagnosed multiple myeloma in the era of modern therapies—back to the future!

Publication date: Available online 17 January 2020Source: Best Practice &Research Clinical HaematologyAuthor(s): Dickran Kazandjian, Alexander Dew, Elizabeth HillAbstractState of the art treatment for myeloma involves using 3-drug combinations incorporating immunomodulatory drugs (IMiDs) and proteasome inhibitors (PIs). Clinical trials for 4-drug combinations incorporating monoclonal antibodies added to IMiD and PI based backbones are underway. Recent retrospective analyses show that patients who attain MRD negativity have similar long term outcomes regardless of early or delayed high dose melphalan with autologous stem cell support (HDM-ASCT). Given HDM-ASCT toxicity, not “overtreating” would be beneficial. Short of data from future prospective clinical trials addressing the question of the role of HDM-ASCT in MRD negative patients, varying expert opinions inherently arise. In this paper, we present the historical context of HDM-ASCT and data supporting 3-drug combinations. We then propose that a viable option for patients who reach MRD negativity is to transition to maintenance therapy directly without early HDM-ASCT, and reserving stem cell harvest to cases where HDM-ASCT is a possibility at relapse.
Source: Best Practice and Research Clinical Haematology - Category: Hematology Source Type: research

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ConclusionHigh-dose chemotherapy and autologous stem cell transplant using TBC conditioning for both PCNSL and secondary CNS non-Hodgkin lymphoma appears to have encouraging long term efficacy with manageable side effects.
Source: Clinical Lymphoma Myeloma and Leukemia - Category: Cancer & Oncology Source Type: research
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Source: Clinical Lymphoma Myeloma and Leukemia - Category: Cancer & Oncology Source Type: research
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Source: Nuclear Medicine Communications - Category: Nuclear Medicine Tags: Original Articles Source Type: research
We retrospectively analyzed 48 CNS lymphoma patients who received HDC/ASCT using TBC conditioning. We found a 2-year PFS and OS rate of 80.5% and 80.1%, respectively. Toxicities included nausea/vomiting, diarrhea, mucositis, and febrile neutropenia. Treatment-related mortality was 8.3% in the first 100 days post-transplant. This data supports the use of consolidative ASCT in PCNSL and secondary CNS lymphoma patients.
Source: Clinical Lymphoma, Myeloma and Leukemia - Category: Hematology Authors: Tags: Original Study Source Type: research
The study is evaluating daratumumab plus lenalidomide, bortezomib, and dexamethasone in autologous stem cell transplant eligible patients newly diagnosed with multiple myeloma.
Source: CancerNetwork - Category: Cancer & Oncology Authors: Source Type: news
Bone Marrow Transplantation, Published online: 17 February 2020; doi:10.1038/s41409-020-0829-1LDH and renal function are prognostic factors for long-term outcomes of multiple myeloma patients undergoing allogeneic hematopoietic stem cell
Source: Bone Marrow Transplantation - Category: Hematology Authors: Source Type: research
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Source: Cancers - Category: Cancer & Oncology Authors: Tags: Article Source Type: research
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Source: Clinical and Experimental Neuroimmunology - Category: Neurology Authors: Tags: REVIEW ARTICLE Source Type: research
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Source: Cancers - Category: Cancer & Oncology Authors: Tags: Article Source Type: research
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