High dose (conditioning) regimens used prior to autologous stem cell transplantation in multiple myeloma

The use of autologous stem cell transplantation (ASCT) in multiple myeloma (MM) is the standard of care in patients who are deemed transplantation eligible. Novel therapies, namely immunomodulatory drugs, proteasome inhibitors, and monoclonal antibodies, have revolutionized the treatment algorithm for MM but have not yet resulted in a cure. To achieve long-lasting disease control in MM, a high-dose conditioning regimen followed by ASCT continues to be an essential part of the management of transplantation-eligible patients with MM. High-dose (or conditioning) regimens are preparative chemotherapy-based regimens used before ASCT. High-dose melphalan is the most commonly used regimen in MM treatment. This clinical review provides an evidence-based summary to guide practicing hematologists/oncologists in the various high-dose regimens used before ASCT in MM treatment. We highlight the use of single-agent melphalan along with various combination-based high-dose regimens with their clinical efficacy. Various dosing schedules and modifications, timing of administration, and novel drugs-based combination regimens are discussed.