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Allogeneic HSCT Retains Role in Relapsed Myeloma

Brandon Scalea
Published: Friday, Mar 15, 2019

Dr Sergio A. Giralt

Sergio A. Giralt, MD

Allogeneic hematopoietic stem cell therapy (HSCT) is a reasonable and often curative option for patients with relapsed multiple myeloma, particularly in those who are younger with high-risk disease, said Sergio A. Giralt, MD.

, Giralt discussed recent data with allogeneic HSCT and why this long-standing modality remains an integral part of treatment for patients with relapsed myeloma.

OncLive: What is the current treatment landscape for patients with multiple myeloma?

Giralt: The treatment landscape has changed dramatically over the last 2 decades, but it usually follows a simple pattern. Patients who require treatment will get induction therapy, usually with a combination of an immunomodulatory agent, proteasome inhibitor, and steroids. After 4 to 6 cycles, they will have their stem cells collected and undergo 1 or 2 transplants.

In the last year, we have actually heard interesting results of chimeric antigen receptor (CAR) T-cell therapy in myeloma—[it is associated with] very high response rates. Allogeneic HSCT is when patients receive high doses of chemotherapy and radiation, and then they receive stem cells from a human leukocyte antigen (HLA) compatible donor. This procedure has been done now for more than 2 decades, but it's the only procedure that is associated with long-term disease control and curative strategies for relapsed myeloma. There are novel techniques to make allogeneic HSCT better and faster for patients in the future. We consider it a valid strategy for patients—particularly young patients with relapsed disease.

What are the biggest benefits of allogeneic HSCT in myeloma?

Allogeneic HSCT for relapsed multiple myeloma has a long track record. Next, it is associated with chances for long-term disease control or clinical benefit. The results have also improved dramatically over the last few years, and it should be considered a valid therapeutic option for young patients with relapsed disease [that has relapsed multiple times]. It can even be considered as part of upfront treatment for young patients with high-risk disease.

Could you expand on the follow-up data that have used HSCT in patients who have relapsed more than once?

There have been a variety of randomized trials looking at allogeneic HSCT in the upfront setting of multiple myeloma. BMT CTN 0102 was one of the largest studies in which patients who had an HLA compatible donor were assigned to undergo allogeneic HSCT as consolidation of an autologous transplant.
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