Treatment of newly diagnosed multiple myeloma in transplant-eligible patients

Treatment of myeloma has changed significantly in the past decade as a result of better understanding of disease biology, more effective treatments, and improved supportive care. Autologous stem cell transplantation (SCT) is an effective treatment for myeloma and remains a critical component in its management. Given the potential impact of therapy on stem cell collection, initial treatment decisions in myeloma still depend on the patient's transplant eligibility. The goals of initial therapy remain rapid disease control allowing for reversal of disease complications, as well as reduction in the risk of early death-all with minimal toxicity. The introduction of new drugs such as thalidomide, bortezomib, and lenalidomide has enabled us to achieve this goal, and combinations of these drugs have also led to unprecedented response depth. In addition, the newer drugs are being explored as maintenance therapy following SCT. This review summarizes the current approach to the treatment of newly diagnosed myeloma in transplant-eligible patients.