Who should get auto allo or mini allo treatment?

Who should get auto allo or mini allo treatment?

So we do a lot of mini allo transplants here at our institution and it has changed over the years. So the groups to which I still don't have any problems offering this are young people with very high risk disease. So people who have plasma cell leukemia and who are under the age of 50. For them, anything that we do will result in very short remissions. And there is nothing, then if the patient is willing to go forward with a mini allo transplant.

The national mortality rate for mini allo transplants these days for myeloma is about 5 to 8%. In some centers, it's actually lower than 5%, close up to two or 3%. So if the patients understand that the risk is higher, then with an auto transplant, and they are willing to go forward based on the risk of their disease, we offer it to young people, especially with very high risk disease. The very high risk means people with multiple mutations, including the high risk mutations and people with plasma cell leukemia, people who have chemo refractory disease, and that they got excellent chemotherapy.

The modern triplets are at the second line chemotherapy still no response, and people are rapidly progressing from their first auto transplant. Generally, people who take progressed within 18 months of an auto transplant have an exceptionally short overall survival. And at that point you have to think about the immune system and to harness the immune system's power to control this patients.

Another group who are eliminated from many clinical trials at this point is people who have predominantly extramedullary disease, which means the disease is mostly outside the bone marrow and growing in various parts of the body without having a big m-spike or a light chain burden. So those patients are typically excluded from the clinical trials, even for things like CAR-T cells or BiTEs modern immunotherapy approaches, and then the transplant becomes a viable immunotherapy option for them. It is the crudest form of immunotherapy the allo transplant.