A study, led by Dr. Joan Bladé, researcher of the Haematooncology Group of Hospital Clínic-IDIBAPS (Barcelona), in collaboration with Dr. Laura Rosiñol, researcher of the same group, assessed the efficiency in terms of response and survival of autologous bone marrow transplantation in patients suffering from refractory myeloma previously having undergone high-dose chemotherapy (HDT). Results were conclusive; in patients suffering from resistant myeloma, neither did transplantation show any benefits nor increased survival.
This research work, conducted within the frame of the PETHEMA network, was carried out from October 1999 to December 2000. It was coordinated from Hospital Clínic, Barcelona and had the participation of the six following Spanish hospitals: Hospital Clínico de Salamanca, Hospital de Sant Pau, Hospital Son Dureta Palma de Mallorca, Hospital Universitario de Salamanca, Hospital Ramón y Cajal de Madrid, Hospital La Fe de Valencia. A total of 829 patients under 65 years and suffering from newly diagnosed multiple myeloma underwent 6 chemotherapy treatment cycles.
Firstly, researchers observed that approximately 10% of patients treated with chemotherapy did not respond to the therapy. The group of treated patients suffering from refractory myeloma was divided into two separately investigated subgroups. The first, formed by 62 % of the total number of patients, consisted of refractory patients presenting a stable, non-progressing disease. The second group, the remaining 38%, suffered from progressive disease. Until now, it was believed that the fraction of patients which did not show any response to prior treatment was the most benefited group from subsequent transplantations. Nevertheless, results obtained by this trial unveiled a different idea.
After conducting subsequent autologous bone marrow transplantations in all patients, researchers observed that refractory patients suffering from progressive myeloma did not show any benefit regarding survival. The disease progressed despite of the transplantation. On the other hand, the second group suffering from stable, non-progressive myeloma responded slightly and showed a life time expectancy of 5 more years. This last survival piece of data, a priori interesting, is very similar that obtained from the group of 718 patients which showed response to chemotherapy (HDT). Thus, it still remains to determine whether this improvement of survival in the second group is due to the transplantation, the chemotherapy treatment or to patient's indolent myeloma.
About multiple myeloma
Multiple myeloma is a type of bone marrow cancer, consisting in abnormal proliferation of plasma cells --blood cells producing antibodies that help the body's immune system fight disease. The treatment for this kind of cancer consists of a therapy provoking a decrease in tumour cells previous to successful autologous bone marrow stem cells transplantation.
The pre-transplantation therapy used until now made patients undergo chemotherapy.
The above story is based on materials provided by Institut d'Investigacions Biomèdiques August Pi i Sunyer. Note: Materials may be edited for content and length.
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