A Mixed-Methods Study of Stem Cell Transplantation Utilization for Newly Diagnosed Multiple Myeloma

Current guidelines recommend that autologous hematopoietic stem cell transplantation (AHSCT) be considered for all eligible patients with multiple myeloma during first-line treatment. However, less than one-third of patients in the United States undergo the procedure. The reasons for this are unclear.

We performed a mixed-methods study including qualitative interviews of patients who declined AHSCT at a high-volume regional transplantation center.

Over a 12-month period, 63% (129/206) of patients underwent AHSCT during first-line therapy. The consulting physician deemed 26% (47) ineligible. An additional 11% (23) were eligible but declined. In the qualitative interviews, 3 themes emerged regarding AHSCT refusal: (1) possible toxicity and disruption in quality of life; (2) unclear gains of AHSCT versus standard chemotherapy; and (3) the sense that transplantation was not suggested for them specifically, rather it was "the routine"; we coined this theme "impersonalized medicine."

On the basis of our findings, we stress the importance of providers helping patients weigh the respective benefits and outcomes of AHSCT and non-AHSCT treatment approaches during the clinical encounter, a key tenet of shared decision-making.