Mini-allogeneic stem cell transplantation
In recent years, the process of allogeneic transplantation has been refined and mini-allogeneic transplantation involving lower doses of conditioning chemotherapy which suppresses rather than destroys the patient’s immune system has been used successfully for myeloma patients.
This lower, less toxic dose of chemotherapy has proven to be more tolerable for patients, helping to reduce the relatively high mortality rates previously seen with the traditional fully myeloablative conditioning treatment.
When the donor cells are injected into the patient, cells from both the donor and the patient co-exist in the patient’s body for some time after the transplant. This allows for a graft-versus-myeloma effect to develop which can work to destroy residual myeloma cells not eliminated by the chemotherapy. It is more effective to use mini-allogeneic transplants when disease burden is low, therefore they are most often performed as a tandem procedure after an autologous transplant. However, GVHD remains a problem and there is a higher incidence of relapse compared to conventional allogeneic transplantation.