HEMATOPOIETIC PROGENITOR-CELL TRANSPLANTATION IN MULTIPLE-MYELOMA

The median survival of conventionally treated patients with multiple m yeloma is 3 years. Modifications of conventional chemotherapy and the administration of interferon-alpha have failed to show an improved sur vival in most randomized trials. Therapy with dose-escalated alkylatin g agents (i.e. melphalan 140 mg/m(2)) induced higher remission rates t han conventional treatment. If followed by allogeneic or autologous he matopoietic progenitor cell transplantation. the hematotoxicity of the described dose-escalated treatment could be reduced. Results of trans plantation trials are summarized and discussed, The transplantation of autologous peripheral blood progenitor cells results in a faster hema topoietic reconstitution and a decreased high-dose therapy-related mor bidity compared to autologous bone marrow and should therefore be pref erred. Although the randomized French myeloma trial showed a significa nt survival advantage for patients following autologous transplantatio n, further randomized prospective studies are required to evaluate the role of blood progenitor cell transplantation after high-dose treatme nt in multiple myeloma. Prognostical factors and future treatment moda lities for myeloma are discussed.