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Sydney 2005:
State of the Art of Allogenic Transplantation in MM
By Gosta Gahrton, MD
Dr. Gahrton gave a state-of-the-art update on allogenic transplantation in MM. Transplantation activity increased dramatically from 1992 to 2002 and a dramatic improvement in survival was noted after 1994, the latter related predominantly to a decrease in transplant related mortality. Relapse rates following transplant are lower if a molecular remission is not achieved. Striking data from long term investigation of allogeneic transplantations show that for male patients, use of a female donor correlates with a significantly lower relapse rate. Dr. Gahrton pointed out that this was a new finding; earlier evaluations transplant mortality showed high mortality in transplants in males with female donor than with male donor. However, since 1994, relapse rates offset mortality rates. Prognostic factors correlating with good outcome of transplants are stage 1 disease, only 1 line of chemotherapy before transplantation, and response to previous therapy. Dr. Gahrton noted that an increase in the number of reduced conditioning (RIC) transplants compared with standard regimen transplants were conducted since 1997. Relapse rates were significantly higher with RIC than with standard transplants but OS was not significantly different. Treatment related mortality is lower in RIC than in standard transplants. Overall, RIC has improved since 2002.

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