Time to Autologous Stem Cell Transplant in Multiple Myeloma Patients: A Real-World Single Centre Experience from...

The standard treatment for transplant-eligible multiple myeloma (MM) patients includes 3-4 cycles of induction therapy followed by autologous stem cell transplantation (ASCT). However, in real-world, resource-limited settings, implementing this sequence is often challenging. This study aimed to evaluate how closely clinical practice at our center aligns with guideline-recommended treatment timelines, particularly in terms of time to ASCT, number of induction cycles, and factors contributing to delays. We conducted a retrospective analysis of MM patients who underwent ASCT between July 2013 and June 2023 at a tertiary cancer center in Kerala, India. Data on demographics, induction regimens, timing of transplant, and documented reasons for delay were extracted from medical records. Among 86 patients who underwent ASCT, 66 (76.75%) received upfront transplants and 20 (23.25%) underwent salvage chemotherapy prior to transplant. The median age was 51 years, and 59.3% were male. The median time from diagnosis to transplant was 12.07 months-approximately twice that reported in Western populations. In the upfront group, the median number of induction cycles was 5, and the median interval from last induction to transplant was 5.01 months. Only 12.8% of patients underwent ASCT after the recommended 3-4 induction cycles. Institutional waiting time (55%) and financial constraints (23%) were the most common causes of delay. Only one in eight patients received ASCT within the recommended timeline. Expanding capacity, streamlining referrals, and providing financial support are key to reducing delays and improving real-world practice.

The online version contains supplementary material available at https://doi.org/10.1007/s12288-025-02221-6.