BONE-MARROW TRANSPLANTATION IN MULTIPLE-MYELOMA

Since 1987, about 250 patients undergoing allogeneic or autologous bone marrow transplantation (BMT) for multiple myeloma have been reported. Most of the patients belonged to advanced tumor stages and had received extensive chemotherapy prior to BMT. Complete remission rates (CR, mostly defined as bone marrow plasma cells < 5% and absence of paraproteins in serum and urine) after allogeneic and autologous BMT were 40% and 35%, respectively. Most of the complete remissions after autologous BMT seemed not to be durable, whereas 40% of the patients entering CR after allogeneic BMT achieved long term disease tree survival.This difference may be attributed to a graft versus myeloma effect of allogeneic BMT. Therapy-related mortality after autologous BMT was low with an early death rate < 10%. After allogeneic BMT 35% of patients died of therapy-related complications. Based on these preliminary data, we surmise that allogeneic BMT offers the chance of cure to young patients with multiple myeloma even in advanced tumor stages. Autologous BMT in multiple myeloma may significantly prolong median survival in myeloma patients with a low therapy-related mortality. but the large majority of patients does not achieve long-term discase-free survival.