GRAFT-VERSUS-MYELOMA

Whereas patients with multiple myeloma continue to relapse after autol ogous transplantation and are unlikely to be cured, the probability of progression is less after allogeneic transplantation and a proportion of patients may be cured. This is attributable to an immunologically mediated graft-versus-myeloma (GVM) effect which is akin to the well-k nown graft-versus-leukemia effect. The available clinical and experime ntal evidence strongly support the existence of GVM, but it is not kno wn whether GVM is separable from graft-versus-host disease (GVHD) in p ractice. The best way to exploit GVM reactions is unclear, and the mor bidity and mortality associated with GVHD undermine long-term survival , There is usually a time lag of a few weeks between immune interventi on and disease response. There is a propensity for extramedullary dise ase recurrence in patients whose marrow disease is controlled with imm unologic manipulation. Exploration of GVM outside conventional allogen eic transplantation or after autologous transplantation is necessary t o increase the number of patients likely to benefit from this phenomen on and to make it safer. This article reviews the currently available literature on the subject.