Dr. Hari on Misconceptions Regarding Allogeneic Stem Cell Transplant in Multiple Myeloma

Parameswaran Hari, MD, MRCP
Published: Thursday, Mar 19, 2020



Parameswaran Hari, MD, MRCP, the Armand J. Quick/William F. Stapp Professor of Hematology, and the chief of the Division of Hematology/Oncology, Department of Medicine, at the Medical College of Wisconsin, discusses misconceptions regarding allogeneic stem cell transplant (allo-SCT) in multiple myeloma.

It is often thought that patients who undergo allo-SCT are more likely to develop a life-threatening infection, graft-versus-host disease (GVHD), or an immune-related complication, says Hari. However, the risk of relapse remains the biggest concern following allo-SCT.

It also believed that relapse after allo-SCT is more aggressive, says Hari. However, data has shown that patients who relapse after allo-SCT are more likely to be alive at 5 years compared with patients who relapse after an autologous stem cell transplant.

Notably, the majority of patients do not require life-long immune suppression to prevent chronic (c)GVHD after allo-SCT. Rather, about 10% of patients require immunosuppressive treatment at 10 years, and just over half of patients require treatment for cGVHD at some point following allo-SCT.

Lastly, allo-SCT was thought to be reserved for patients with high-risk multiple myeloma. While this patient population has the best risk-benefit ratio for allo-SCT, patients with standard-risk disease may also derive benefit from allo-SCT. Notably, young patients with standard-risk multiple myeloma should be considered for allo-SCT as potentially curative treatment, concludes Hari.
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Parameswaran Hari, MD, MRCP, the Armand J. Quick/William F. Stapp Professor of Hematology, and the chief of the Division of Hematology/Oncology, Department of Medicine, at the Medical College of Wisconsin, discusses misconceptions regarding allogeneic stem cell transplant (allo-SCT) in multiple myeloma.

It is often thought that patients who undergo allo-SCT are more likely to develop a life-threatening infection, graft-versus-host disease (GVHD), or an immune-related complication, says Hari. However, the risk of relapse remains the biggest concern following allo-SCT.

It also believed that relapse after allo-SCT is more aggressive, says Hari. However, data has shown that patients who relapse after allo-SCT are more likely to be alive at 5 years compared with patients who relapse after an autologous stem cell transplant.

Notably, the majority of patients do not require life-long immune suppression to prevent chronic (c)GVHD after allo-SCT. Rather, about 10% of patients require immunosuppressive treatment at 10 years, and just over half of patients require treatment for cGVHD at some point following allo-SCT.

Lastly, allo-SCT was thought to be reserved for patients with high-risk multiple myeloma. While this patient population has the best risk-benefit ratio for allo-SCT, patients with standard-risk disease may also derive benefit from allo-SCT. Notably, young patients with standard-risk multiple myeloma should be considered for allo-SCT as potentially curative treatment, concludes Hari.

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