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 ?
Superiority of tandem autologous transplantation over standard therapy for previously untreated multiple myeloma.
Virtually no progress has been made during more than 2 decades of clinical trials for multiple myeloma ( MM ) involving st and ard therapy ( ST ) . Recent studies suggest that dose intensification requiring hematopoietic stem cell support results in higher complete response ( CR ) rates and extended disease control .  " Total Therapy " ( TT ) consisting of noncross-resistant induction regimens , followed by a double autotransplant ( AT ) procedure , was administered to 123 untreated patients with symptomatic MM . Upon hematologic recovery , interferon ( IFN ) maintenance ( 3 million units [MU]/m2 subcutaneously thrice weekly ) was given until disease recurrence/progression . Results were compared with the outcome of untreated patients receiving ST according to Southwest Oncology Group ( SWOG ) trials . One hundred sixteen pair mates were selected from both TT and among 1,123 patients to match for the major prognostic features . TT induced CR in 40 % of all 123 patients ( intent-to-treat ) . By 12 months , 7 % had died , including 4 % from treatment-related complications . With a median follow-up of 31 months , median duration s of event-free survival ( EFS ) and overall survival ( OS ) are 49 and 62 + months , respectively . Abnormalities of chromosomes 11q and 13 were associated with inferior outcome , whereas CR within 6 months after induction was a favorable prognostic feature for both EFS and OS . In comparison to ST , TT induced higher PR rates ( 85 % v 52 % , P < .0001 ) ( CR rates not available on SWOG trials ) and extended EFS ( 49 v 22 months , P = .0001 ) and OS ( 62 + v 48 months , P = .01 ) . Compared to ST , dose intensification with double AT markedly augments tumor cytoreduction , effecting not only higher CR rates but also significantly extending EFS and OS in previously untreated patients with MM
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 ?