The Role of High-Dose Chemotherapy and Stem-Cell Transplantation in Patients with Multiple Myeloma: A Practice Guideline of the Cancer Care Ontario Practice Guidelines Initiative

16 April 2002 | Volume 136 Issue 8 | Pages 619-629

The Hematology Disease Site Group of the Cancer Care Ontario Practice Guidelines Initiative has systematically reviewed the published literature and, through a consensus process, developed an evidence-based practice guideline assessing the role of stem-cell transplantation in patients with multiple myeloma. The conclusions were validated by solicited feedback from 221 practitioners across Ontario, Canada. The guideline comprises six recommendations: 1) Autologous transplantation is recommended for patients with stage II or III myeloma and good performance status. Evidence of benefit is strongest for patients who are younger than 55 years of age and have a serum creatinine level less than 150 µmol/L [<1.7 mg/dL]. Physicians must use clinical judgment in recommending transplantation to other patients. 2) Allogeneic transplantation is not recommended as routine therapy. 3) Patients potentially eligible for transplantation should be referred for assessment early after diagnosis and should not be extensively exposed to alkylating agents before collection of stem cells. 4) Autologous peripheral blood stem cells should be harvested early in the patient's treatment course. The best available data suggest that transplantation is most advantageous when performed as part of initial therapy. 5) The comparative data addressing the specifics of the transplantation process are insufficient to allow definitive recommendations. In the absence of such data, a single transplant with high-dose melphalan, with or without total-body irradiation, is suggested for patients undergoing transplantation outside a clinical trial. 6) At this time, no conclusions can be reached about the role of interferon therapy after transplantation.

*For members of the Hematology Disease Site Group of the Cancer Care Ontario Practice Guidelines Initiative, see Appendix.

Author and Article Information

From the Cancer Care Ontario Program in Evidence-Based Care, Ontario, Canada.

Grant Support: This program is supported by Cancer Care Ontario and the Ontario Ministry of Health and Long-Term Care.

Requests for Single Reprints: Ralph M. Meyer, MD, Hamilton Regional Cancer Centre, 699 Concession Street, Hamilton, Ontario L8V 5C2, Canada; e-mail, ralph.meyer{at}hrcc.on.ca.

Current Author Addresses: Dr. Imrie: Toronto–Sunnybrook Regional Cancer Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.

Ms. Esmail: Calgary Regional Health Authority, 1035–7th Avenue Southwest, Calgary, Alberta T2P 3E9, Canada.

Dr. Meyer: Hamilton Regional Cancer Centre, 699 Concession Street, Hamilton, Ontario L8V 5C2, Canada.