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ABSTRACT
Introduction: Autologous Stem Cell Transplantation (ASCT) represents the standard treatment in eligible “de-novo” multiple myeloma (MM) patients.
Areas covered: ASCT may be single or tandem, and a single ASCT can be followed by an allogeneic (Allo)-SCT. A systematic review has been conducted to examine the current evidence for the efficacy of using a tandem transplant strategy in MM.
Expert opinion: A tandem ASCT approach should be considered for all patients, although the benefit from the second ASCT in patients who are in complete remission or experience a very good partial response should be answered in a clinical trial. Recent results with the new induction regimens indicate that there is a role for tandem ASCT in the presence of adverse cytogenetic abnormalities. Planned AlloSCT after ASCT has not been found to be superior in the majority of studies and is not recommended outside of a clinical trial. However, single or tandem ASCT are both appropriate options and participation in prospective clinical trials should be encouraged to resolve the debate in the era of novel agents for MM.
Article highlights.
Autologous stem cell transplantation (ASCT) represents the standard treatment in eligible multiple myeloma (MM) patients.
ASCT may be single or tandem (a planned second course of high-dose chemotherapy within 6 months of the first).
Single or tandem ASCT are both appropriate options.
The benefit from the second ASCT in patients who are in complete remission or very good partial response should be answered in a clinical trial.
Recent results with the new induction regimens suggest that there is a role for tandem ASCT in the presence of adverse cytogenetic abnormalities.
Planned allogeneic SCT after ASCT or as salvage therapy for relapsed MM is not recommended outside of a clinical trial.
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Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents, received or pending, or royalties.