There is no evidence that marrow transplantation is curative, for the disease recurs in most patients.
This form of treatment is experimental. The role of marrow transplantation is being tested in several randomized clinical trials in North America and Europe.
• With allogeneic transplantation, bone marrow is given from a matched donor following high-dose
chemotherapy and total body irradiation. The mortality is high (20-25 percent within the first three months)
and the patient often suffers from a peculiar form of rejection called graft-versus-host disease , in which the
transplanted marrow attacks the host tissue .
This procedure is also possible only for people under 55, which greatly limits its use in multiple myeloma .
Only 5 to 10 percent of multiple myeloma patients can have an allogeneic bone marrow transplantation
because of their age and the lack of a matched donor.
• Autologous transplantation—in which bone marrow or peripheral blood stem cells are removed from a patient
before high-dose radiation or chemotherapy and then returned—is applicable for more patients because the
age limit is higher (approximately 65 years) and a matched donor is unnecessary. The mortality rate for
autologous transplantation is less than 10 percent.
But there are two major problems with autologous transplantation for patients with multiple myeloma.
First, it is difficult to destroy all the myeloma cells from the bone marrow even with high doses of
chemotherapy and radiation. Second, it is difficult to remove the malignant myeloma cells from the bone
