Autologous Stem Cell Transplantation In Multiple Myeloma: Is It Still The Right Choice?

Autologous stem cell transplantation (ASCT) is considered the standard of care for multiple myeloma patients aged <65 years with no relevant comorbidities. The addition of proteasome inhibitors and/or immunomodulatory drugs has significantly increased the percentage of patients achieving a complete remission after induction therapy, and these results are maintained after high-dose melphalan (Alkeran®), leading to a prolonged disease control. Studies are being carried out in order to evaluate whether short- term consolidation or long-term maintenance therapy can result in disease eradication at the molecular level, thus also increasing patient survival. The efficacy of these new drugs has raised the issue of deferring the transplant after achieving a second response upon relapse. Another controversial point is the optimal treatment strategy for high-risk patients, that do not benefit from ASCT, and for whom the efficacy of new drugs is still matter of debate.