The role of transplant in multiple myeloma

Over the past decades significant therapeutic advances have been made in the treatment of multiple myeloma (MM). A population-based study of 45,595 patients showed substantial incremental increases in myeloma-specific survival in patients younger than 80 years treated between 1973 and 2009. Depth of response to therapy has long been associated with improved long-term outcomes. Autologous stem cell transplantation (ASCT) was previously the only modality capable of inducing a very good partial response (VGPR) or complete response in a substantial proportion of patients. The introduction of 2 classes of novel agents, immunomodulatory drugs and proteasome inhibitors, resulted in induction regimens that achieve VGPR rates exceeding 60% even before transplant, thus challenging the role of ASCT. Allogeneic stem cell transplantation (allo-SCT) has also been tested in patients with MM; however, its current role remains undefined given the high rates of transplant-related mortality and chronic graft-versus-host disease. Posttransplant consolidation and maintenance strategies have further improved progression-free and overall survivals. This article discusses the current roles of ASCT, allo-SCT, and consolidation and maintenance therapies in the management of MM.