However, eligibility and projected success depend heavily on pre-allo-HCT evaluation [26]

However, eligibility and projected success depend heavily on pre-allo-HCT evaluation [26]. which there is an observed synergy in the modulation of the immunologic microenvironment. Furthermore, tailored patient selection by evaluating pre-transplant factors including high-risk cytogenetics, age, and pre-salvage International Staging System (ISS) can predict post-transplantation success including non-relapse mortality. Successive research should continue to revise and update treatment options as the evolving therapeutic drug regimens may change over the course of indolent disease. strong class=”kwd-title” Keywords: stem cell transplant for hematological malignancies, multiple myeloma, graft vs myeloma, allogenic bone marrow transplant, allogeneic stem cell transplant recipients Introduction and background Multiple myeloma (MM) affects five in every 100,000 people yearly [1] and makes up about 10% of all hematological cancers overall [1,2]. It is an indolent B-cell malignancy involving long-lived plasma cells, which remain in the bone marrow and produce antigen-specific immunoglobulin; however, malignant plasma cell clones produce an excess of light chains, which contribute to the pathology of the disease in addition to restraining the intended immune defense [3]. Rabbit Polyclonal to AQP3 An asymptomatic precursor stage called smoldering MM (SMM) represents an intermediary between MM and indolent monoclonal gammopathy of unknown significance (MGUS) [4,5]. MGUS, affecting roughly 3% of people over the age of 50 years, converts to MM MX-69 or a comparable malignancy yearly at about MX-69 1% [6]. Currently, the treatment of MM is aimed at preventing organ dysfunction from light chain accumulation (slowing disease progression) and inducing remission in far-progressed patients [4,7]. Although average survival has improved, post-diagnosis life expectancy remains around 7-10?years, making MM an incurable malignancy to this day [8]. Allogeneic hematopoietic stem cell transplantation (allo-SCT) has the potential to induce remission to a potentially curative-like state through graft versus myeloma (GVM) effects [9]. Sustained molecular remission accomplished by donor lymphocyte infusion (DLI) may evidence GVM effects; however, the standard of care for MM is a combination of autologous hematopoietic stem cell transplantation (auto-SCT) and high-dose melphalan, which itself as a conditioning agent is shown to reduce overall mortality [9-12]. Approved chemotherapeutic treatment for relapse and refractory cases of MM currently can involve a multidrug cocktail of panobinostat, bortezomib, and dexamethasone, which shows some clinical success [13-16]. Both allo-SCT and auto-SCT, despite procedural advances, may incur significant morbidity and mortality even with tailored patient selection [17,18]. Durable remissions have been shown in allo-SCT; however, the unacceptably high rates of MX-69 treatment-related mortality are yet to be resolved; while auto-SCT exhibits less durable remission but a comparably lower rate of peri-transplantation mortality [2]. Although the use of allo-SCT remains controversial, to date, complete remission after allo-SCT is the most important prognostic factor for patients achieving long-term survival [19,20]. Currently, allo-SCT is considered a viable treatment option only in patients with severe disease [20].?While the risks and benefits must be carefully considered in any treatment modality, the potential reservoir of curative-like remission should be further evaluated, as allo-SCT is not the current standard of care. The high risks comprehended in allo-SCT treatment eliminate its potential as an option for treatment of non-responders in moderate to moderate disease; however, the potentially curative success in some patient groups warrants further evaluation to elucidate mortality-reducing methods [20]. This systematic review explores the current literature on the use of allo-SCT in MM and evaluates when allo-SCT should be considered over other treatment options. Figure ?Physique11 demonstrates the general actions involved in stem cell extraction and transplantation [21]. Figure 1 Open in a separate window The general process of stem cell transplantation. Review Methods Protocol We performed a systematic review following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [22]. Inclusion/Exclusion Criteria We conducted a literature search to identify studies that assessed MM and stem cell transplantation (SCT), particularly allo-SCT. The criteria implored to gather relevant articles included (1) MM patients treated with allo-SCT and (2) any outcomes in MM patients considered for allo-SCT. We focused on chronic multiple myeloma patients without any age or gender discrimination. Articles that reported on MM patients undergoing.

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