Multiple myeloma, high-dose treatment and autologous stem cell transplantation--current status.

High-dose chemo-radiotherapy with autologous stem cell transplantation (ASCT) has introduced the concept of complete remission for multiple myeloma, and can improve survival and life quality for selected groups of myeloma patients. A number of prognostic factors have been identified, where ASCT in early disease, i.e. as part of front-line treatment, seems to be of particular importance for a favourable outcome. Even so, most myeloma patients will not be cured by high-dose therapy, but new strategies such as repeated autografting and post-graft alpha-interferon maintenance treatment seem to add additional advantages with respect to survival and freedom of disease progression. The technical development has enabled efficient in vitro myeloma cell depletion of the autograft as well as highly sensitive detection of minimal residual disease after treatment, but the clinical significance of these issues remains to be determined, and this question is addressed in ongoing gene marking studies. The application of novel therapeutic principles, e.g. gene therapy and immunotherapy, might further ameliorate the outcome for patients with multiple myeloma.