Allogeneic stem cell transplantation (allo SCT) for multiple myeloma (MM) may exhibit graft versus myeloma effects (GVM) without contamination with tumor cells. It has been used as the only treatment method that may achieve the cure of myeloma. However, in comparative studies with autologous stem cell transplantation (auto SCT), the treatment-related mortality was high in patients who underwent allo SCT, not leading to an improvement in the prognosis; this procedure remains at the stage of experimental therapy. Recently, the introduction of proteasome inhibitors and immunomodulatory drugs has improved the results of MM treatment. A new therapeutic strategy for allo SCT involving a combination of these drugs should be developed.
Recent studies demonstrated that donor engraftment was achieved without severe graft-versus-host disease (GVHD) after posttransplant cyclophosphamide (PTCy) based human leukocyte antigen (HLA) -haploidentical bone marrow transplantation (PTCy-haploBMT). It has been suggested that PTCy selectively deplete proliferating alloreactive T cells, while preserving regulatory T cells. Although GVHD and non-relaplse mortality appears to be low, relapse remains a major problem after PTCy-haploBMT. Recently, PTCy is increasingly used in the setting of peripheral blood stem cell transplantation or myeloablative stem cell transplantation in order to reduce rejection and disease relapse. Furthermore, this strategy can be applied to patients with nonmalignant disorders. This strategy also represents a promising platform to establish calcineurin-inhibitor free GVHD prophylaxis in HLA-identical stem cell transplantation.
Severe oral mucosal lesions are frequently observed during hematopoietic stem cell transplantation (HSCT). We investigated the improvement of oral mucosal lesions in patients before and after introducing professional oral health care (POHC) interventions prior HSCT. We retrospectively investigated 107 recipients of HSCT. Logistic regression analysis was used to evaluate the severity of oral mucosal lesions as an objective variable, and POHC interventions prior to transplantation, age, sex, stem cell source of transplantation, intensity of conditioning regimen, prior history of transplantation, total body irradiation, post-transplant methotrexate (MTX), and risk of recurrence as explanatory variables. As a result, oral mucosal lesions were proven to be correlated with POHC interventions prior to transplantation (p=0.006 ; odds ratio[OR], 0.307) and post-transplant MTX (p=0.007 ; OR, 3.291). This suggests that POHC interventions prior to HSCT and oral hygiene instructions to patients are effective in improving the severity of oral mucosal lesions during HSCT.