Cures stem from high doses.

Stem-cell transplants (SCT) have awe-inspiring rates of cure--and mortality--which have fed passionate debates in the liquid tumor world for decades. These are awesome procedures with awful complexity, leaving many oncologists with the educated opinion of, huh? We’re here to break it down and then top it off with some recent data. Autologous, as opposed to allogeneic, SCT is an option for people with malignancies arising from more differentiated cell-lines, as is the case with, say, multiple myeloma (MM). In other words, a patient with MM can safely “rescue” herself from lethal doses of chemo using her own cancer-free stem-cells harvested prior to total chemo ablation. A 2018 meta-analysis reevaluates, in the setting of modern systemic therapies, the 20-year standard of high (aka myeloablative, aka deadly) doses of melphalan with autologous SCT rescue as first-line therapy for MM. This combined analysis of a trio of modern phase 3 trials comparing this standard to various de-escalations of sorts demonstrates a loss of progression-free survival (PFS) times with the newer tested regimens. What’s more, autologous SCT followed by more chemo and/or another (aka tandem) SCT further improved PFS. Bottom line, when it comes to curing MM, less is less.