Stem cell transplantation (SCT) has been used in the treatment of multiple myeloma (MM) for decades and has become a standard of care for newly diagnosed MM patients. However, several important questions remain regarding the optimal use of SCT, particularly in light of the many recent advances in the treatment of MM. Bortezomib-based therapy or, in some cases, lenalidomide-based therapy should be considered as an induction therapy in transplantation-eligible patients. Efforts to improve upon the efficacy and safety of standard transplantation regimens (that is, high-dose melphalan) are also underway. Most published studies on the use of tandem autologous SCT were conducted before the advent of novel agents, such as thalidomide, lenalidomide and bortezomib, making it difficult to establish the current role of tandem SCT. Allogeneic SCT continues to be evaluated in clinical trials, and may have an important role in the treatment of transplantation-eligible patients with suitable donors. Post-transplantation consolidation and maintenance therapy using novel agents should be considered to improve outcomes in patients who fail to achieve a complete response following SCT. Patients in remission should be advised that continued therapy has been shown to prolong remission, improve quality of life and extend survival. Additional data on the optimal approach to post-transplantation therapy are needed. New strategies in development aimed at improving patient selection, safety and efficacy of SCT are likely to improve future outcomes.
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We thank Shanthi Jayawardena, PhD, and Eva Polk, PhD (Excerpta Medica), for the linguistic improvement of the manuscript. Editorial support in the preparation of this manuscript was funded by Celgene Corporation. WB is supported by the NIH fund: NIH/NCI 5R21CA155911.
SG and WB were fully responsible for all content and editorial decisions for this manuscript.
WB has participated in a speakers bureau and advisory board, and has received clinical research support from Celgene Corporation. He has also participated in an advisory board and has received clinical research support from Millennium and Onyx Pharmaceuticals. WB has also received grant support from AstraZeneca and Acetylon Pharmaceuticals. SG has had a consultancy role and received honoraria from Biokine Therapeutics, Miltenyi Biotech, Onyx, Celgene Corporation and Sanofi; he has also received lecture fees and grants from Celgene Corporation.
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Giralt, S., Bensinger, W. Stem cell transplantation for multiple myeloma: current and future status. Leukemia Suppl 2, S10–S14 (2013). https://doi.org/10.1038/leusup.2013.3
- autologous stem cell transplantation
- allogeneic stem cell transplantation
- multiple myeloma
Clinical Lymphoma Myeloma and Leukemia (2014)