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Augmenting Autologous Stem Cell Transplantation to Improve Outcomes in Myeloma

Maybury, B; Cook, G; Pratt, G; Yong, K; Ramasamy, K; (2016) Augmenting Autologous Stem Cell Transplantation to Improve Outcomes in Myeloma. Biology of Blood and Marrow Transplantation , 22 (11) pp. 1926-1937. 10.1016/j.bbmt.2016.06.004. Green open access

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Abstract

Consolidation with high-dose chemotherapy and autologous stem cell transplantation (ASCT) is the standard of care for transplantation-eligible patients with multiple myeloma, based on randomized trials showing improved progression-free survival with autologous transplantation after combination chemotherapy induction. These trials were performed before novel agents were introduced; subsequently, combinations of immunomodulatory drugs and proteasome inhibitors as induction therapy have significantly improved rates and depth of response. Ongoing randomized trials are testing whether conventional autologous transplantation continues to improve responses after novel agent induction. Although these results are awaited, it is important to review strategies for improving outcomes after ASCT. Conditioning before ASCT with higher doses of melphalan and combinations of melphalan with other agents, including radiopharmaceuticals, has been explored. Tandem ASCT, consolidation, and maintenance therapy after ASCT have been investigated in phase III trials. Experimental cellular therapies using ex vivo–primed dendritic cells, ex vivo–expanded autologous lymphocytes, Killer Immunoglobulin Receptor (KIR)-mismatched allogeneic natural killer cells, and genetically modified T cells to augment ASCT are also in phase I trials. This review summarizes these strategies and highlights the importance of exploring strategies to augment ASCT, even in the era of novel agent induction.

Type: Article
Title: Augmenting Autologous Stem Cell Transplantation to Improve Outcomes in Myeloma
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.bbmt.2016.06.004
Publisher version: https://doi.org/10.1016/j.bbmt.2016.06.004
Language: English
Additional information: Available under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) (https://creativecommons.org/licenses/by-nc-nd/4.0).
Keywords: Multiple myeloma, Stem cell transplantation, Conditioning, Immunotherapy, Minimal residual disease
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute > Research Department of Haematology
URI: https://discovery.ucl.ac.uk/id/eprint/10050393
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