Although a reasonable and often curative treatment option, use of allogeneic hematopoietic stem cell therapy in relapsed multiple myeloma still tends to fall under the radar.
Although a reasonable and often curative treatment option, use of allogeneic hematopoietic stem cell therapy (HSCT) in relapsed multiple myeloma still tends to fall under the radar, according to Sergio A. Giralt, M.D.
The procedure, which has been around for more than two decades, is the only therapeutic strategy that has demonstrated curative potential in patients who relapse after primary therapy, added Giralt — a professor of medicine at Weill Cornell Medical College, the Melvin Berlin Family Chair in Multiple Myeloma and chief attending of Adult Bone Marrow Transplant Service at Memorial Sloan Kettering Cancer Center.
“Allogeneic HSCT is a valid option and it should not be automatically dismissed just because it has been available for 20 years,” he explained in an interview with CURE’s sister publication, OncLive. “We are the first to recognize that results are not what we want them to be. However, there are a number of innovative clinical trials exploring allogeneic HSCT that will hopefully improve outcomes for these patients. More importantly, for a young patient with multiple-relapsed disease, allogeneic HSCT offers a chance for disease control.”
In the relapsed setting, the Food and Drug Administration has approved 10 agents to treat multiple myeloma, which has led to much debate over the standard of care for these patients.
However, Giralt recommended for patients and their providers to consider allogeneic HSCT — not only because of its veteran status among the various treatment options, but also because 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],” he added. “It can even be considered as part of upfront treatment for young patients with high-risk disease.”
One such trial has aimed to validate allogeneic HSCT as an upfront therapy: the phase 3 BMT CTN 0102 was one of the largest studies in which patients who had a human leukocyte antigen (HLA) compatible donor were assigned to undergo allogeneic HSCT as consolidation of an autologous transplant.
Patients with standard-risk myeloma did not benefit from the procedure; however, after an eight-year follow-up, there are more patients who did not relapse in the allogeneic arm with high-risk disease than those who received an autologous transplant.
“The risk of relapse was reduced in patients who received an allogeneic HSCT,” Giralt explained. “This suggests there is a graft-versus-myeloma effect that is more operative in patients with high-risk cytogenetic abnormalities and that this strategy needs to be pursued further.”