Who should consider an allo transplant?

Who should consider an allo transplant?

Allogenic transplant in multiple myeloma.

I will honestly say that the indications for an allogenic transplant in 2022 soon going into 2023, are very, very few patients. Most of us would not consider an allogeneic transplant necessarily upfront. There are certain situations where, very high risk, very young patients that you might want to have a conversation with your transplant physician. But with all of the new immunotherapies that we have available, I think allogeneic transplant is kind of lowest on my list of options.

I think that number one, I think you need to consider it if there's a clinical trial available. I think that for patients who have, we think have high risk disease. And so the way I view that is, is that patients will have things like a 17p deletion or mutation in P53. I think that if you're younger, I think that you can probably withstand the allo better than if you're older. So typically I like to view them as a way of transplanting people instead of doing an autologous transplant. I would consider doing an allogenic transplant in a patient who's younger who has high risk disease.

I think that if you go take them through ten rounds of therapy, having five different lines of therapy, then it's not going to work. So it's going to work better, just like everything works better the earlier you use it, the allo is going to work earlier. And I think that those are probably the best candidates.

The one thing about an allo versus an auto is an allo can be curative like it has side effects that you don't see in an auto. But for young individuals, like if we can stretch out their life, their lifespan by ten or 15 years, that's great. But for a 40 year old that gets in the 50 or 55. And so I think that for younger patients, we like to try to stretch out as much as possible. I think an allo is one way to do that. But that is like it's a very controversial thing, but they still are available at certain centers.