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Transplant in myeloma: individualized approaches needed depending on context, access and biology

Bone Marrow Transplantation volume 60, pages 3–5 (2025)Cite this article

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Dramatic advances in the treatment of multiple myeloma (MM) have led to improved survival. The backbone of therapy over the last decade has been triplet therapy consisting of proteasome inhibitors such as bortezomib, immunomodulatory drugs such as lenalidomide and steroids [1]. With a triplet backbone of bortezomib, lenalidomide, dexamethasone (VRd), excellent outcomes have been observed [2], and the recent addition of anti-CD38 monoclonal antibodies to up-front therapy is prolonging this first remission further [3].

What high-dose chemotherapy followed by autologous stem cell rescue (ASCT) adds here remains a heated topic of discussion. Two trials have evaluated the role of ASCT in the context of VRd induction therapy [4, 5], both trials showed a compelling PFS benefit to the use of ASCT, but no overall survival benefit at the latest follow-up. A dramatic short-term reduction in quality of life was seen with the use of ASCT. These trials have been done in countries with access to subsequent therapies, and these results are applicable at a population level, which may not extrapolate well to an individual patient with specific disease biology that increases their risk of recurrence, or a patient in a part of the world that may not have access to other therapies upon relapse. In this perspective, we discuss three patient cases, each from different areas of the world, highlighting how a one-size-fits-all approach to ASCT does not serve all our patients well.

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Authors and Affiliations

  1. Hematology Service, University Hospital “Dr. José Eleuterio González” UANL, Monterrey, Nuevo León, México

    Héctor A. Vaquera-Alfaro & Andrés Gómez-De León

  2. Princess Margaret Cancer Centre, Toronto, ON, Canada

    Nihar Desai

  3. Cancer Institute, WIA, Chennai, India

    Nikita Mehra

  4. Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA

    Ghulam Rehman Mohyuddin

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  1. Héctor A. Vaquera-Alfaro
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  2. Andrés Gómez-De León
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  3. Nihar Desai
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  4. Nikita Mehra
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  5. Ghulam Rehman Mohyuddin
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Contributions

GRM and HAVA conceived and developed the first draft of the manuscript. AGDL, ND, and NM contributed to discuss each case and edited the manuscript. All authors have revised and approved the final version of this manuscript.

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Correspondence to Héctor A. Vaquera-Alfaro.

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Vaquera-Alfaro, H.A., Gómez-De León, A., Desai, N. et al. Transplant in myeloma: individualized approaches needed depending on context, access and biology. Bone Marrow Transplant 60, 3–5 (2025). https://doi.org/10.1038/s41409-024-02428-7

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