Stem cell transplantation for multiple myeloma: current and future status

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.