Allogenic stem-cell transplantation for multiple myeloma with reduced intensity conditioning regimen: systemic literature and network meta-analysis

Posted on by Muthanna Medical Journal

Research article

Volume 11, Issue 1,  2024.  Page 54-72    10.52113/1/1/2024-1-72

Authors Nasser Ghaly Yousif 1, 2* , Fadhil G. Alamran 3 , Ulrich Aran Nöth 4
Ahmed Altmimi 5    

*Correspondence author: yousif_ghaly@mu.edu.iq
*1 Department of Medicine, College of Medicine, Al-Muthanna University.
2 EX. University of Colorado Denver, Department of Medicine and Surgery Aurora, Denver, CO, 80045, USA
3 Department of Surgery, Medical College, Kufa University, Kufa, Iraq
4 Department of Regenerative Research, College of Medicine, Colorado University, Colorado.
5 Department of Biology, Ministry of Health, Iraq.
Received 14 November 2023; revised 11 March 2024; accepted 14 April 2024, available online 23 May 2024. Copyright © 2024 Alkubaisi. This is article distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Abstract

Multiple myeloma (MM) is a hematologic malignancy characterized by neoplastic proliferation of monoclonal plasma cells in the bone marrow (BM). The catastrophic expansion and accumulation of transformed plasma cells in the BM is driven by their acquisition of unique and complex genetic and epigenetic alterations, allowing them to attain unprecedented selective growth advantages, clonotypic persistence, and resistance to treatment. These causes are further augmented by the presence of structural and functional abnormalities in the BM microenvironment. Despite remarkable advances in drug discovery, patient responses to therapy usually remain at best transient, with the vast majority of individuals ultimately succumbing to overt disease progression and cancer-related death. Established risk factors such as t(4;14), 1q21 gain, and chromosome 13 deletion gain are associated with aggressive disease phenotypes and poor outcomes. Allogeneic stem-cell transplantation (allo-SCT) can mount a graft-versus-tumor (GVT) effect capable of eradicating residual malignant plasma cells. However, its use has been limited by an increased risk of transplant-related morbidity and mortality (TRM), often associated with a graft-versus-host disease (GVHD) (acute or chronic) usually resulting in immune dysregulation capable of leading to increased risk of opportunistic infections (OIs) (viral, fungal, and parasitic). Reduced-intensity conditioning (RIC) regimens have been developed to counteract these issues. To date, the available data for RIC-allo-SCT in MM is represented by single cohort studies. Therefore, a systematic literature and network meta-analysis was performed to evaluate the outcomes and toxicities of RIC-allo-SCT in patients with MM compared with other stem cell transplant strategies, namely autologous SCT, myeloablative allo-SCT, and no transplant. Sixteen studies fulfilled the eligibility criteria, yielding a total of 3728 policies and 23863 patients. In conclusion, RIC-allo-SCT in MM leads to an increased chance of survival compared with no transplant, is preferable to autologous-SCT in relatively younger patients with more adverse baseline characteristics and offers comparable outcomes to the myeloablative-allo-SCT group with an acceptable risk of grade III-IV acute GVHD, TRM, and grade II-IV chronic GVHD.

Keywords: Allogenic stem-cell transplantation, Multiple myeloma, Reduced-intensity conditioning regimen, Meta-analysis

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Volume 11, Issue 1, 2024

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Yousif NG, Alamran FG, Nöth UA, Ahmed Altmimi. Allogenic stem-cell transplantation for multiple myeloma with reduced intensity conditioning regimen: systemic literature and network meta-analysis. Muthanna Medical Journal. 2024; 11(1):54-72.