Research Shows Stem Cell Transplant as Effective Multiple Myeloma Treatment
October 21, 2003
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ARLINGTON HEIGHTS, ILStem cell transplantation is more effective than standard chemotherapy as first-line therapy for patients with multiple myeloma, a type of blood cancer, according to the first evidence-based review of transplant as a treatment option for the disease. The treatment recommendations were made after an extensive analysis of the published medical literature by an independent panel of experts. The review was sponsored by the American Society of Blood and Marrow Transplantation (ASBMT) and published in the societyís journal, Biology of Blood and Marrow Transplantation.
"This information is important for multiple myeloma patients and their physicians as they make treatment decisions and seek reimbursement from health insurers for transplantation," said John Wingard, MD, University of Florida College of Medicine, Gainesville, and chair of the expert panel on multiple myeloma.
Multiple myeloma, which is diagnosed in 15,000 people each year, is a cancer of plasma cells in the bone marrow. The disease varies from patient to patient, ranging from mild illness that requires careful monitoring but no treatment, to more serious disease that requires aggressive therapy. According to the panel, stem cell transplant is recommended as first-line (de novo) therapy for multiple myeloma when the disease requires treatment.
Stem cell transplant is a technique in which healthy stem cellsthe cells which give rise to plasma cells and other blood componentsare collected from the circulating blood (called peripheral blood stem cell transplantation, or PBSCT) or from bone marrow (bone marrow transplant, or BMT). The panel also concluded:
- Based on the available evidence and expert opinion, stem cell transplant using cells from circulating blood is better than a transplant using stem cells from bone marrow and is the standard of care for the therapy.
- Stem cell transplant is equally effective as therapy for patients who do not respond to treatment with chemotherapy and/or radiation therapy or whose disease recurs after those treatments. "The survival of patients who receive stem cell transplant after failing prior treatments is comparable to survival in patients who receive transplant as first-line therapy. Stem cell transplant as a first-line therapy is preferred, however, because it may avoid the risks and costs of treating the potential complications of chemotherapy," Dr. Wingard said.
- Stem cell transplant using the patientís own stem cells is currently the standard of care compared to transplant with donor cells, but studies are ongoing to compare and evaluate the roles of the two techniques in the treatment of multiple myeloma.
- A technique in which the stem cells for transplant are harvested from the bone marrow of the patient and treated to remove diseased cells is not an effective treatment for multiple myeloma.
The review, The Role of Cytotoxic Therapy with Hematopoietic Stem Cell Transplantation in the Therapy of Multiple Myeloma: An Evidence-Based Review, appears in Volume 9, Number 1 of Biology of Blood and Marrow Transplantation and is available online at www.asbmt.org or by contacting Theresa Hahn, PhD, Roswell Park Cancer Institute, Buffalo, N.Y., lead author of the review, at firstname.lastname@example.org, or phone (716) 845-5819.
Co-authors of the review with Drs. Wingard and Hahn are Kenneth C. Anderson, MD, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; William I. Bensinger, MD, the Fred Hutchinson Cancer Research Center, Seattle, WA; James R. Berenson, MD, Cedars Sinai Medical Center, Los Angeles, CA; Greg Brozeit, International Myeloma Foundation, Hollywood, CA; Joseph R. Carver, MD, Abramson Cancer Research Institute, University of Pennsylvania, Philadelphia, PA; Robert A. Kyle, MD, Mayo Clinic, Rochester, MN; and Philip L. McCarthy, MD, Roswell Park Cancer Institute, Buffalo, NY.
ASBMT in 1999 began the development of evidence-based reviews of the scientific and medical literature to document when blood and marrow transplantation is indicated in the treatment of selected diseases.
"Although transplantation has been widely accepted by the medical community for certain diseases, it is often considered experimental by third-party payer groups," said Roy Jones, MD, University of Texas, M.D. Anderson Cancer Center, Houston, and chair of the ASBMT Steering Committee overseeing the reviews. "This review documents when stem cell transplant is the preferred, most effective therapy. We hope it will help every patient obtain access to the best treatment for his or her condition," he said.
The American Society for Blood and Marrow Transplantation is a national professional association that promotes advancement in research, education and clinical practice of cellular therapy and blood and bone marrow transplantation. ASBMT members are in both research and clinical practice.
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