Is there still a role for stem cell transplantation in multiple myeloma?

Abstract

High‐dose chemotherapy and autologous stem cell transplantation (ASCT) are a standard of care for transplant‐eligible patients with newly diagnosed multiple myeloma (MM). The introduction of novel agents, which range from immunomodulatory drugs and proteasome inhibitors to monoclonal antibodies and have now been integrated into both induction and salvage regimens, has dramatically revolutionized the treatment landscape of MM and challenged the role of high‐dose chemotherapy and ASCT in treating MM. These advances have led to a number of provocative questions. First, what is the current role of stem cell transplantation (SCT) in comparison with standard‐dose therapy incorporating novel agents? Second, should ASCT be performed upfront (“early”) or later (“delayed”) in the course of the disease? Third, should single or double ASCT be performed? Fourth, is allogeneic SCT still an option for patients with MM? This article provides an overview of available data and evidence‐based responses regarding the role of SCT in MM.

Minimal Residual Disease in Multiple Myeloma: State of the Art and Future Perspectives

“…High-dose melphalan plus ASCT is a standard intensification strategy for the treatment of newly diagnosed (ND)MM patients younger than 70-75 years of age [63]. The role of ASCT has been frequently challenged in the past, but all studies reported a PFS advantage for patients receiving ASCT, as compared to no ASCT, although with an inconsistent OS benefit [62,[64][65][66].…”

Comparison of single and double autologous stem cell transplantation in multiple myeloma patients

“…The role of tandem ASCT as an upfront treatment in cases with MM and its advantage over single ASCT are a matter of debate [11,12]. The development of extramedullary plasmacytomas during proteasome inhibitor treatment is also associated with an unfavorable prognosis in MM [13], and tandem ASCT could be considered in such cases.…”

Multiple myeloma: an overview of management

“…In addition, a second autologous transplant can be performed if the patient received a significant benefit from the first transplant, commonly considered as a minimum of 18–24 months of remission. 32 In this way, many patients control their disease with sequential lines of treatment for many years; 47% of people diagnosed with MM in England and Wales survive their disease for 5 years or more and 33% survive their disease for 10 years or more. 1…”