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First-line tandem high-dose chemotherapy and autologous stem cell transplantation versus single high-dose chemotherapy and autologous stem cell transplantation in multiple myeloma, a systematic review of controlled studies

Creator:

naumann-Winter, F., et a

Subject Keywords: Tandem autologous stem cell transplantation (TASCT), Single autologous stem cell transplantation (SASCT), Symptomatic MM, Overall survival (OS), Event-free survival (EFS), Quality of life (QoL)
Type: Article
Region: International (other)
Description:

Multiple myeloma is a cancer of antibody-producing cells in the bone marrow. It causes bone destruction and patients are usually at a higher risk for infections and renal damage. Autologous stem cell transplantation has been established as standard initial treatment for fit patients with symptomatic multiple myeloma. During autologous stem cell transplantation, blood-forming stem cells are removed from the patient prior to intense chemotherapy and later given back to the same patient. The chemotherapy is aimed at killing tumour cells (the higher the dose the more tumour cells are killed) but also affects normal blood-forming cells that are needed to fight infections, transport oxygen and control bleeding. By giving the patient back his or her own blood-forming cells, the recovery from the chemotherapy is notably faster and better. Since it is unclear whether autologous stem cell transplantation as initial treatment of multiple myeloma should be performed once or twice, we systematically searched for publications addressing the question whether the acute toxicity of autologous stem cell transplantation is counterbalanced by a long-term benefit for the patient. Several studies in which patients undergoing one treatment with autologous stem cell transplantation were compared to patients undergoing autologous stem cell transplantation twice were identified. Only five of 14 studies identified could be analysed in the present systematic review. We were interested in long-term benefit for patients with respect to overall survival or so called event-free survival, that is survival without disease progression. Quality of life and treatment-related mortality should also be analysed in clinical studies.

When the included studies were analysed with respect to treatment regimen and design characteristics, all turned out to have methodological problems which do not allow us to draw firm conclusion from the findings. Since the way to treat multiple myeloma has changed since the performance of the included trials, conclusions cannot be drawn with respect to contemporary treatment decisions. We also noted that reporting of completed trials needs to be improved.

Date:

17/10/2012

Rights: © The Cochrane Collaboration
Suggested citation:

naumann-Winter, F., et a. (2012) First-line tandem high-dose chemotherapy and autologous stem cell transplantation versus single high-dose chemotherapy and autologous stem cell transplantation in multiple myeloma, a systematic review of controlled studies [Online]. Available from: http://publichealthwell.ie/node/300801 [Accessed: 21st September 2019].

  

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