Role of autologous bone marrow transplant in multiple myeloma

The treatment of newly diagnosed multiple myeloma has evolved rapidly over the recent years. In younger patients, autologous stem cell transplantation (ASCT) is still considered the standard of care, but the availability of new effective drugs with novel mechanisms of action in the last decade has resulted in a new scenario that has caused the role of transplantation itself to be currently undergoing scrutiny.

Maintaining the response of first-line therapy is an important objective in multiple myeloma, where despite intensive therapy followed by ASCT the majority of patients will relapse. In this field, the recent results of different consolidation and maintenance therapies after transplant are very encouraging. These strategies have come to stay and will play an essential role in the next future to improve the prognosis of young patients with newly diagnosed multiple myeloma. Finally, new conditioning regimens will also be tested in the forthcoming years in an attempt to further improve posttransplant responses.

Multiple myeloma ASCT must be integrated within a more global therapeutic approach including new and more effective induction, consolidation, and maintenance approaches. Efforts aimed in the development of more effective and less toxic preparative regimens to further augment disease control are also warranted.