High-dose therapy in multiple myeloma.

Autologous transplantation in myeloma can prolong survival as compared with standard chemotherapy but cannot be considered curative, as the majority of patients relapse within 5 years. Contaminating myeloma cells can be detected in stem cell harvests in the majority of patients, and the possibility that these cells lead to relapse has prompted widespread current interest in the use of positive stem cell selection as a means of purging. Allogeneic bone marrow transplantation is associated with a high transplant-related mortality but a lower relapse risk. A graft-versus-myeloma effect has recently been proven by the demonstration of response to donor lymphocyte infusion in patients relapsing after allogeneic bone marrow transplantation.