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Stem-Cell Transplant Key to Early Multiple Myeloma Therapy

Autologous hematopoietic stem-cell transplantation should be part of initial treatment

WEDNESDAY, June 17 (HealthDay News) -- Despite the emergence of novel agents to treat multiple myeloma, a combination of high-dose therapy and autologous hematopoietic stem-cell therapy continues to be the best initial treatment, according to an article published in the June 18 issue of the New England Journal of Medicine.

Jean-Luc Harousseau, M.D., of the Rene Gauducheau Cancer Center in Nantes-Saint Herblain, France, and Philippe Moreau, M.D., of the University Hospital Hotel Dieu in Nantes, France, use the example of a 59-year-old man who presented with lower back pain and fatigue, and who was subsequently diagnosed with multiple myeloma. As he was relatively young and had no coexisting illness, the recommended treatment was induction therapy then high-dose therapy together with autologous hematopoietic stem-cell transplantation.

Although some experts recommend initial therapy comprising a combination of dexamethasone and lenalidomide or a triple agent combination with bortezomib instead of early transplantation, the authors still recommend transplantation because life expectancy is more than 80 percent at five years after transplantation and because lenalidomide is not yet approved for newly diagnosed patients in many countries. The authors further note that lack of data is also an issue.

"Given the lack of long-term data, the durability of the response and the efficacy of salvage treatment after the use of novel agents remain unknown whereas data regarding autologous stem-cell transplantation are more mature," Harousseau and Moreau conclude.

Both authors reported financial relationships with several pharmaceutical companies.

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