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 ?
High-dose therapy and autologous peripheral blood stem cell transplantation in multiple myeloma: up-front or rescue treatment? Results of a multicenter sequential randomized clinical trial.
Results to date indicate that high-dose therapy ( HDT ) with autologous stem cell support improves survival of patients with symptomatic multiple myeloma ( MM ) . We performed a multicenter , sequential , r and omized trial design ed to assess the optimal timing of HDT and autotransplantation . Among 202 enrolled patients who were up to 56 years old , 185 were r and omly assigned to receive HDT and peripheral blood stem cell ( PBSC ) autotransplantation ( early HDT group , n = 91 ) or a conventional-dose chemotherapy ( CCT ) regimen ( late HDT group , n = 94 ) . In the late HDT group , HDT and transplantation were performed as rescue treament , in case of primary resistance to CCT or at relapse in responders . PBSC were collected before r and omization , after mobilization by chemotherapy , and , in the two groups , HDT was preceded by three or four treatments with vincristine , doxorubicin , and methylprednisolone . Data were analyzed on an intent-to-treat basis using a sequential design . Within a median follow-up of 58 months , estimated median overall survival ( OS ) was 64.6 months in the early HDT group and 64 months in the late group . Survival curves were not different ( P = .92 , log-rank test ) . Median event-free survival ( EFS ) was 39 months in the early HDT group whereas median time between r and omization and CCT failure was 13 months in the late group . Average time without symptoms , treatment , and treatment toxicity ( TWiSTT ) were 27.8 months ( 95 % confidence interval [ CI ] ; range , 23.8 to 31.8 ) and 22.3 months ( range , 16.0 to 28.6 ) in the two groups , respectively . HDT with PBSC transplantation obtained a median OS exceeding 5 years in young patients with symptomatic MM , whether performed early , as first-line therapy , or late , as rescue treatment . Early HDT may be preferred because it is associated with a shorter period of chemotherapy
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 ?