Therapeutic decision making in hematopoietic stem cell transplantation for multiple myeloma

Diagnosis page 139 Adverse prognostic factors 141 Standard-dose therapy in the up-front treatment of multiple myeloma 142 CIBMTR data for multiple myeloma 151 Indications for transplantation 152 Contraindications to Transplantation 152 Pretransplant workup 152 Monitoring posttransplant 153 Further reading 154 Diagnosis Myeloma is a heterogeneous disease in terms of expected outcomes. The International Staging System (ISS) provides a simple prognostic profile (based on measurements in serum of albumin and β2-microglobulin) (Durie et al., 2006). ISS can identify patients with expected survivals ranging from less than 2.5 years to more than 5 years. Whether high-risk patients should benefit from more aggressive approaches, such as up-front allogeneic hematopoietic stem cell transplantation (HSCT), has not been evaluated in formal clinical trials. A molecular genetic profile is a promising approach to identify patients who may or may not respond to specific drugs/drug combinations. It may be possible in the future to predict the drugs and the intensity of the therapy that should be used in an individual patient. The prognosis of multiple myeloma overall has improved because of the widespread use of autologous transplantation and improved supportive care (Kristinsson et al., 2007).