Allogeneic hematopoietic cell transplantation in multiple myeloma

Due to the inability to cure multiple myeloma (MM) with current therapies, including autologous stem cell transplantation (auto-SCT), there has been a sustained interest in allogeneic hematopoietic cell transplantation (allo-HCT) given its use of a myeloma-free donor cell graft and the possibility of a donor-driven, immune-mediated graft-versus-MM effect. This chapter begins with a discussion on the risks of allo-HCT in MM. Several randomized trials have attempted to evaluate the tandem auto-SCT-allo-HCT approach versus tandem auto-SCT in the upfront transplant setting. The chapter explains when allo-HCT can be offered in the disease course of MM. It also presents two case studies dealing with the genetically defined high-risk myeloma in a young patient and plasma cell leukemia (PCL). It concludes with a discussion on lenalidomide (LEN), and bortezomib.