Transplant in myeloma: what is its role?

Quadruplet induction regimens containing anti-CD38 monoclonal antibodies in combination with a triplet backbone are providing deeper and more durable responses in newly diagnosed multiple myeloma (NDMM) patients, and at the same time, questioning the role of autologous stem cell transplant as part of consolidation, especially in certain subgroups. While several studies are evaluating the rate of sustained minimal residual disease (MRD) achieved when combining quadruplet regimens to transplant, other studies are focusing on the relevance of pursuing transplant in those who achieved MRD with induction. Current evidence supports autologous stem cell transplant as a key consolidation strategy while ongoing studies refine risk-adapted and MRD-guided approaches. We have yet to see how new immunotherapies that are moving to front-line therapy will challenge the role of transplant in the future.