Abstract: |
It has been more than 30 years since McElwain and Powles demonstrated the benefits of high-dose melphalan in the treatment of relapse and refractory myeloma. With autologous hematopoietic cell support high-dose melphalan has become the best available strategy to achieve high CR rates and prolong PFS as consolidation of a proteosome inhibitor, immune-modulatory drug, and steroid induction therapy. However, the best timing of HCT remains an area of active debate and major interest with most ongoing clinical trials showing progression-free survival benefit and some showing survival benefit. Although significant advances have been made in myeloma therapy no major changes have occurred in the setting of high-dose melphalan therapy. In this chapter we review current status and future directions of high-dose therapy for myeloma. © Springer International Publishing AG 2018. |