Autologous and Allogeneic Transplantation for Multiple Myeloma

The conventional treatment of myeloma frequently results in the achievement of a stable “plateau” phase during which patients have minimal or no symptoms related to their disease; however, during this phase, patients still have a considerable tumor burden. Conventional treatment with melphalan, melphalan and prednisolone, or combination chemotherapy regimens including cyclophosphamide, melphalan, carmustine (BCNU), lomustine (CCNU), adriamycin, vincristine, and prednisolone result in a median survival of between 24 and 36 mo, with approx 50% of patients responding to therapy. However, only a minority (5–10%) of patients attained a true complete remission (CR), with the disappearance of paraprotein and a normal marrow (1,2). Following the introduction of infusional chemotherapy, such as vincristine adriamucin dexamethasone (VAD), the number of patients responding to treatment (70–80%) and the level of response achieved increased, with CR rates of 8–28% (3,4). These responses were often short-lived, and it was with the purpose of improving the duration of response that high-dose therapy (HDT) was introduced (5).