Allogeneic bone marrow transplantation in multiple myeloma

Allogeneic transplantation in multiple myeloma can induce complete remissio n, defined as disappearance of abnormal immunoglobulins in the blood, light chains in the urine and no apparent myeloma cells in the marrow, in about 50 percent of patients. The five-year survival is about 30 percent and impo rtant prognostic factors for survival are to be a female, to be in stage I at the time of diagnosis Irrespective of the time of transplantation, to ha ve received only one line of treatment before transplantation, to have resp onsive disease and a low beta2-microglobulin. Transplant-related mortality is between 40-50 percent, and therefore overall survival is poorer than wit h autologous transplantation, while long-term survival is similar with both transplant modalities. Although the relapse rate of patients in complete r emission is about 50 percent at 5 years, it is still lower than with autolo gous transplantation. Donor lymphocyte transfusion to patients with persist ent abnormal immunoglobulins or relapse may induce regression or new comple te remissions. Further studies aim at reducing transplant-related mortality by using peripheral blood stem cells, CD34-selected cells, more aggressive anti-bacterial, anti-fungal and anti-viral treatment and relapse rate will be counteracted by donor lymphocyte transfusions and perhaps post-transpla nt interferon treatment.