The Hematology DSG noted that the use of transplantation for patients with myeloma varied among practice s across the province .
In terms of survival , is  peripheral blood stem-cell  or  marrow transplantation better than conventional chemotherapy ?
What is the relative efficacy of autologous versus allogeneic transplantation ?
What specifics of the transplantation process can be recommended ?
The addition of interferon is unlikely to influence outcomes in the control group .
In Terms of Survival , Is Autologous Peripheral Blood Stem-Cell or Bone Marrow Transplantation Better than Conventional Chemotherapy ?
After more than three decades of clinical trials testing various st and ard-dose chemotherapy regimens , the disease course of patients with multiple myeloma has not changed appreciably .
Conventional chemotherapy can provide effective palliation but is not curative ( 1 ) .
Case series have described encouraging results in patients with myeloma undergoing allogeneic or autologous bone marrow or peripheral blood stem-cell transplantation ( 2 ) .
Other studies of transplantation , including r and omized trials , have been reported in the past 6 years ( 3 , 4 ) .
To facilitate decisions about treatment options , practice guidelines have been developed for use by health care providers and consumers .
In Ontario , Canada , cancer treatments and policies are led by a state-funded organization , Cancer Care Ontario .
To help derive treatment options , Cancer Care Ontario has developed the Program in Evidence -Based Care , which includes the Practice Guidelines Initiative .
To approach this topic , the DSG addressed the following questions : What is optimal st and ard-dose chemotherapy for patients with myeloma ?
When should transplantation be performed ?
Who should ( or should not ) receive a transplant ?
Transplantation in patients with multiple myeloma: a multicenter comparative analysis of peripheral blood stem cell and allogeneic transplant.
We performed a multicenter comparative analysis of autologous peripheral blood stem cell transplantation ( PBSCT ) and allogeneic bone marrow transplantation ( alloBMT ) in multiple myeloma . Forty-eight consecutive patients received either PBSCT ( 24 patients ) or alloBMT ( 24 patients ) at one of three institutions in the study group . Preparatory regimens consisted of melphalan and total body irradiation ( TBI ) or melphalan alone in the PBSCT group . The alloBMT group received one of four regimens : cyclophosphamide and TBI ; cyclophosphamide , VP-16 and 1,3-bis(2-chloroethyl)-1-nitrosourea ( CVB ) ; busulfan and cyclophosphamide ( BU/CY ) and total marrow irradiation ( TMI ) ; or melphalan and TBI .  Procedure-related mortality was 12.5 % for the PBSCT group and 25 % for the alloBMT group . With a median follow-up for survivors in the PBSCT and alloBMT groups of 11 months ( range , 4 - 46 ) and 15 months ( range , 2 - 84 months ) , respectively , there was no significant difference in median overall survival ( 33.5 versus 38.6 months , p = 0.7637 ) or event-free survival ( 16.7 versus 31 months , p = 0.8450 ) . There was , however , a plateau in survival at 40 % in the alloBMT group . No plateau in survival was seen in the PBSCT group . Clinical relapses occurred as late as 39 months posttransplant . Patients have survived up to 28 months postrelapse
The Hematology DSG noted that the use of transplantation for patients with myeloma varied among practice s across the province .
In terms of survival , is  peripheral blood stem-cell  or  marrow transplantation better than conventional chemotherapy ?
What is the relative efficacy of autologous versus allogeneic transplantation ?
What specifics of the transplantation process can be recommended ?
The addition of interferon is unlikely to influence outcomes in the control group .
In Terms of Survival , Is Autologous Peripheral Blood Stem-Cell or Bone Marrow Transplantation Better than Conventional Chemotherapy ?
After more than three decades of clinical trials testing various st and ard-dose chemotherapy regimens , the disease course of patients with multiple myeloma has not changed appreciably .
Conventional chemotherapy can provide effective palliation but is not curative ( 1 ) .
Case series have described encouraging results in patients with myeloma undergoing allogeneic or autologous bone marrow or peripheral blood stem-cell transplantation ( 2 ) .
Other studies of transplantation , including r and omized trials , have been reported in the past 6 years ( 3 , 4 ) .
To facilitate decisions about treatment options , practice guidelines have been developed for use by health care providers and consumers .
In Ontario , Canada , cancer treatments and policies are led by a state-funded organization , Cancer Care Ontario .
To help derive treatment options , Cancer Care Ontario has developed the Program in Evidence -Based Care , which includes the Practice Guidelines Initiative .
To approach this topic , the DSG addressed the following questions : What is optimal st and ard-dose chemotherapy for patients with myeloma ?
When should transplantation be performed ?
Who should ( or should not ) receive a transplant ?