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BioMed Research International
Volume 2014 (2014), Article ID 394792, 7 pages
http://dx.doi.org/10.1155/2014/394792
Review Article

Autologous Stem Cell Transplantation in Elderly Patients with Multiple Myeloma: Past, Present, and Future

1Department of Hematology, Tokushima Prefectural Central Hospital, 1-10-3 Kuramoto, Tokushima 770-8539, Japan
2Department of Hematology, Tokai Central Hospital, 4-6-2 Sohara-higashijima, Kakamigahara 504-8601, Japan

Received 2 December 2013; Accepted 14 January 2014; Published 20 February 2014

Academic Editor: Dong Soon Lee

Copyright © 2014 Shuji Ozaki and Kazuyuki Shimizu. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

High-dose melphalan (200 mg/m2) as conditioning regimen followed by autologous stem cell transplantation (ASCT) rescue has been established as a standard treatment for patients with multiple myeloma (MM) younger than 65 years of age. However, the role of ASCT in elderly patients older than 65 years remains controversial in the era of novel agents such as thalidomide, bortezomib, and lenalidomide. The efficacy and feasibility of ASCT have been shown in elderly patients by reducing the dose of melphalan to 100–140 mg/m2. Although the clinical benefit of reduced-intensity ASCT in elderly patients has not been clearly established in comparison with that of novel agent-based induction therapy, recent studies have demonstrated that sequential strategies of novel agent-based induction therapy and reduced-intensity ASCT followed by consolidation/maintenance with novel agents translate into better outcome in the management of elderly patients. Thus, ASCT could also be a mainstay in the initial treatment of elderly MM patients, and its indication should be evaluated based on performance status and the presence of complications and/or comorbidities of each elderly patient with MM.