The treatment of multiple myeloma has dramatically improved in the past 10 years. The availability of new drugs has broadened chemotherapy options; however, complete remissions (CR) are infrequent, and cure is still rare. High-dose therapy followed by autologous or allogeneic stem cell transplant has emerged as a promising means to increase remission rates and improve survival. Autologous transplants have not always shown survival benefits in randomized studies because the majority of patients who undergo transplant relapse, and patients given conventional therapy can receive salvage transplants at the time of relapse. CR has been found to reliably predict survival and thus the efforts to improve remission rates using autologous transplant include tandem transplants, targeted radiation, cytoprotective agents, or posttransplant immunotherapy. Only allogeneic hematopoietic stem cell transplantation is potentially curative, because of an immunologic graft-versus-myeloma effect. High transplant-related mortality associated with allogeneic stem cell transplantation is currently the major limitation to wider use of this modality. Although patients who receive either allogeneic or autologous stem cell transplants for multiple myeloma have similar 3- to 5-year survivals, only allograft recipients appear to enjoy long-term disease-free survival. Promising approaches designed to improve the therapeutic index of allografts include the use of nonablative conditioning regimens, peripheral blood cells rather than bone marrow, graft engineering, and targeted conditioning therapies such as bone-seeking radioisotopes.
Sarah P. Hammond, Sankar Swaminathan, William I. Bensinger and Lindsey R. Baden
Lindsey Robert Baden, William Bensinger, Michael Angarone, Corey Casper, Erik R. Dubberke, Alison G. Freifeld, Ramiro Garzon, John N. Greene, John P. Greer, James I. Ito, Judith E. Karp, Daniel R. Kaul, Earl King, Emily Mackler, Kieren A. Marr, Jose G. Montoya, Ashley Morris-Engemann, Peter G. Pappas, Ken Rolston, Brahm Segal, Susan K. Seo, Sankar Swaminathan, Maoko Naganuma and Dorothy A. Shead
Patients with cancer are at increased risk for developing infectious complications during the course of their disease and treatment. The following sections of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Prevention and Treatment of Cancer-Related Infections provide an overview of the risk factors for infectious complications, recommendations for infectious risk categorization, and strategies for prevention of infections in high-risk patient populations with cancer. Individualized risk evaluation for infections and incorporation of preventative measures are essential components of the overall spectrum of cancer care, and may contribute to optimizing treatment outcomes for patients.