Introduction: Our non-myeloablative transplants for early stage disease program started in 2000 for breast cancer and recommends treatment by combined modalities consisting of intensive or dose dense induction, an autologous transplant strategy and a non-myeloablative reduced intensity conditioning transplant (
Methods: Several databases were searched to provide insight in the matter.
Results: A medline search on dose dense and myeloma showed no articles. Standard treatment in myeloma (melphalan and prednison or VAD) induce 6-10% (complete) responses; the newer agents thalidomide or bortezomib in combination with other agents induce 12 to 16% (complete) response, but the agents are quiet toxic.
Standard CHOP in myeloma has been reported to induce 60 to 65% partial response with very low toxicity (
Non-myeloablative reduced intensity conditioning transplants after high-dose autologous transplants converted 18% complete remission to 70% complete remission and induced long-term disease free survival (
In over 75% the disease was lethal prior to the non-myeloablative transplant era.
Conclusion: Conventional therapy in myeloma has been characterized by few low-dose regimens; myeloma have for years been undertreated. To improve disease outcome a systematic treatment approach from initial diagnosis for any of the stages I to III disease is required and herein discussed.
Disclosure: No relevant conflicts of interest to declare.