Dear Vanessa,
Thank you for posting on the Discussion Forum, I am sorry that you haven?t had many replies. My name is Ellen and I am one of the Myeloma Information Specialists at Myeloma UK. I hope that the following clarifies things for you.
An allogeneic transplant involves the use of stem cells from a donor instead of using the patient?s own stem cells (autologous transplant). Although it can be very effective in inducing a long remission, standard allogeneic transplants unfortunately are associated with substantial side-effects and an increased risk of mortality. In the past few years, doctors have developed what they call a mini-allogeneic transplant which involves the use of lower doses of chemotherapy that is much safer and associated with less severe side-effects yet is effective in treating the myeloma. A standard allogeneic transplant is now very rarely offered.
By way of background and for other forum users who may have some questions, generally speaking, allogeneic stem cell transplants (both standard and mini) are thought to be more effective in controlling the myeloma than autologous stem cell transplants because once established, the donor cells recognise any residual myeloma cells as being foreign and can destroy and remove them. Any residual myeloma cells after an autologous transplant remain and therefore a relapse would occur at some point when the residual myeloma starts to progress again.
Unfortunately, the donor stem cells may also recognise the healthy cells as being foreign and start attacking them ? and this is why allogeneic transplants are much riskier. The vast majority of myeloma patients have an autologous transplant because many are not eligible for an allogeneic transplant either because they do not have a donor match or because of their age (generally restricted to patients under 50-55 years).
There is some research evidence to suggest that having two consecutive transplants (tandem transplant) may be better than one so some patients may be offered a second transplant within six months of their first autologous transplant. The second can be either another autologous transplant or if eligible, a patient may be asked to consider a mini-allogeneic transplant. The reason again for the latter is because of the potential of producing a much longer remission than a second autologous transplant. The research evidence gathered so far is very mixed and not at all clear with some studies reporting a benefit of tandem autologous-mini allogeneic transplants while others do not.
At present, because of the lack of evidence to prove its benefits, a tandem transplant of either kind (autologous-autologous or autologous-mini allogeneic) is not part of routine practice and ultimately the decision would be down to the haematologist offering it.
I hope this has been of some help, but please do not hesitate to get back in touch if you have further questions or would like to talk things through. I and my colleague Maggie can be contacted directly by email to askthenurse@myeloma.org.uk or on the freephone Myeloma Infoline on 0800 980 3332
Ellen
ellen 11 years, 6 months ago.
