Multiple myeloma (MM) is a incurable hematological malignancy with an average survival of 3 years with conventional therapy. Allogeneic hematopoietic cell transplantation (allo - HCT) may cure some patients, but has been associated with a high transplantation-related-mortality (TRM) of over 40%. The potential advantages of allo - HCT are the ability to collect myeloma free stem cells and the graft - versus - myeloma effect. But, despite these factors, long term cure is rare. Relapse continues at a rate of approximately 7% per year with long term follow-up. The graft-versus-host disease (GVHD) can also be a problem, requiring therapy and impairing quality of life. Approaches to improve the outcome of allo - HCT for MM include consideration of patient status, efficacy and toxicity of induction therapy, source of hematopoietic graft, and conditioning regimens. Recent attempts to improve outcome include autologous hematopoietic cell transplantation (AHCT) followed by non - myeloablative allogeneic transplantation, and allo-HCT with T depletion and subsequent donor lymphocyte infusions. With the use of strategies directed at cell signaling, patients' lives can be prolonged, and the quality of their lives can be improved compared with the current approach that transplantation provides, despite its survival benefit.
Multiple myeloma; hematopoietic stem cell transplantation; allogeneic
